Basic Information
| Provider Information | |||||||||
| NPI: | 1073963195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAYLOR | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | TALBOT | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5425 HIGHWAY 6 | ||||||||
| Address2: | STE D-900 | ||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774594387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812089200 | ||||||||
| FaxNumber: | 2812089210 | ||||||||
| Practice Location | |||||||||
| Address1: | 5425 HIGHWAY 6 | ||||||||
| Address2: | STE D-900 | ||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774594387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812089200 | ||||||||
| FaxNumber: | 2812089210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 110442 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.