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General NPI Number Information
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NPI Number | 1427203470
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Entity Type | Individual
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Provider Name | GAYLE LISA AGAR O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 28911 SEVEN MILE ROAD
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City | LIVONIA
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State | MI
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Zip | 48152
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Country | US
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Telephone | 734-968-1524
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Fax | 734-432-6007
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Provider Business Mailing Address
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Address Line | 29623 SHENANDOAH DRIVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-2468
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Country | US
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Telephone | 734-968-1524
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Fax | 734-432-6007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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