Healthcare Provider Details

I. General information

NPI: 1427076132
Provider Name (Legal Business Name): GAIL E HUECKER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

IV. Provider business mailing address

124 JONQUIL CT
MOORESVILLE NC
28117-6677
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-5552
  • Fax: 352-795-7751
Mailing address:
  • Phone: 704-696-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberOT8510
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT8510
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: