Provider Demographics
NPI:1174631618
Name:GIST, BETH ANN (OT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GIST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ELIZBETH
Other - Middle Name:
Other - Last Name:GIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BETH CRABB
Mailing Address - Street 1:503 PARK PLACE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2188
Mailing Address - Country:US
Mailing Address - Phone:254-913-4848
Mailing Address - Fax:
Practice Address - Street 1:1349 EMPIRE CENTRAL DR STE 516
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4066
Practice Address - Country:US
Practice Address - Phone:469-291-8500
Practice Address - Fax:214-265-0420
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther8T6191
TXBCBSOther8T6191