Provider Demographics
NPI:1528472156
Name:MICHAELS-RYAN, GAYLE (COTA/L)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:MICHAELS-RYAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 E THUNDERBIRD RD
Mailing Address - Street 2:#2033
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5681
Mailing Address - Country:US
Mailing Address - Phone:513-252-4193
Mailing Address - Fax:
Practice Address - Street 1:3033 E THUNDERBIRD RD APT 2033
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5687
Practice Address - Country:US
Practice Address - Phone:513-252-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5767224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant