Provider Demographics
NPI:1740550938
Name:TINSLEY, GAIL BULLOCK (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:BULLOCK
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 CAPISTRANO DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2106
Mailing Address - Country:US
Mailing Address - Phone:804-264-2550
Mailing Address - Fax:804-264-2550
Practice Address - Street 1:7706 BRYN MAWR RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6604
Practice Address - Country:US
Practice Address - Phone:804-264-2550
Practice Address - Fax:804-264-2550
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193200000XMedicaid
VA541471254Medicaid
VA541471254Medicaid