Provider Demographics
NPI:1447447297
Name:TEMKIN, GAYLE REVA (MT)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:REVA
Last Name:TEMKIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 OLD MANCHACA RD APT 1908
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1376
Mailing Address - Country:US
Mailing Address - Phone:512-351-5538
Mailing Address - Fax:
Practice Address - Street 1:10801 OLD MANCHACA RD APT 1908
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1376
Practice Address - Country:US
Practice Address - Phone:512-351-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0920OtherMASSAGE THERAPIST