Provider Demographics
NPI:1952752909
Name:GAMELIN, TIA L (OT)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:L
Last Name:GAMELIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 411 BLDG 700 APO AE
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:BADEN WURTTENBURG
Mailing Address - Zip Code:09112
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 411 BLDG 700 APO AE
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:BAVARIA
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:314-476-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2138225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics