Healthcare Provider Details

I. General information

NPI: 1891976916
Provider Name (Legal Business Name): GAIL E. REQUARDT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65539 HIGHLAND HILLS RD
CAMBRIDGE OH
43725-9657
US

IV. Provider business mailing address

PO BOX 1027
CAMBRIDGE OH
43725-6027
US

V. Phone/Fax

Practice location:
  • Phone: 740-432-4824
  • Fax: 740-432-4824
Mailing address:
  • Phone: 740-432-4824
  • Fax: 740-432-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 000432
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: