Individual
BETH ANN GIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1349 EMPIRE CENTRAL DR STE 516, DALLAS, TX 75247-4066
(469) 291-8500
(214) 265-0420
Mailing address
503 PARK PLACE LN, TEMPLE, TX 76504-2188
(254) 913-4848
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
109053
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
8T6191
TX
Enumeration date
08/25/2006
Last updated
08/02/2021
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