Individual
LISA GAYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-2699
(360) 814-5467
Mailing address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-2699
(360) 814-5467
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT00002983
WA
225XP0200X
Pediatric Occupational Therapist
Primary
OT00002983
WA
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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