Provider Demographics
NPI:1427203470
Name:AGAR, GAYLE LISA (OTR)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:LISA
Last Name:AGAR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:GAYLE
Other - Middle Name:BERK
Other - Last Name:AGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29623 SHENANDOAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2468
Mailing Address - Country:US
Mailing Address - Phone:734-968-1524
Mailing Address - Fax:734-432-6007
Practice Address - Street 1:28911 SEVEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-968-1524
Practice Address - Fax:734-432-6007
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist