Provider Demographics
NPI:1720168925
Name:YEAGER, GAYLE H (OT)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:H
Last Name:YEAGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:H
Other - Last Name:KOLAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:100 YMCA LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4352
Mailing Address - Country:US
Mailing Address - Phone:863-382-2949
Mailing Address - Fax:863-382-4732
Practice Address - Street 1:100 YMCA LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-4352
Practice Address - Country:US
Practice Address - Phone:863-382-2949
Practice Address - Fax:863-382-4732
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11307OtherSTATE OF FLORIDA OT LICEN