MEDICARE: VANESSA GABRIELLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	004408	GA

General Provider Information

NPI Number	:	1992826978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA GABRIELLE

Provider Business Mailing Address
First Line	:	415 ARMOUR DRIVE
Second Line	:	1207
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:	404-444-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 ARMOUR DR NE
Second Line	:	1207
City	:	ATLANTA
State	:	GA
Zip	:	30324-3933
Country	:	US
Telephone Number	:	404-444-5353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/24/2009

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Directions to “ VANESSA GABRIELLE ” Practice Location

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