Healthcare Provider Details

I. General information

NPI: 1063636231
Provider Name (Legal Business Name): CHRISTY GAGEL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 TROY PIKE
DAYTON OH
45424-5740
US

IV. Provider business mailing address

4710 TROY PIKE
DAYTON OH
45424-5740
US

V. Phone/Fax

Practice location:
  • Phone: 937-899-1230
  • Fax: 937-236-8930
Mailing address:
  • Phone: 937-899-1230
  • Fax: 937-236-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 3114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: