Healthcare Provider Details

I. General information

NPI: 1942386594
Provider Name (Legal Business Name): GAYLE J PLISCOFSKY O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 STATE ROUTE 197
FORT EDWARD NY
12828
US

IV. Provider business mailing address

PO BOX 87
FORT EDWARD NY
12828
US

V. Phone/Fax

Practice location:
  • Phone: 972-983-2833
  • Fax:
Mailing address:
  • Phone: 518-955-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number005818
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number110770
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: