Healthcare Provider Details

I. General information

NPI: 1205226636
Provider Name (Legal Business Name): STEPHANIE CAMILLE GELLA MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17025 VIA PIEDRAS
SAN LORENZO CA
94580-2845
US

IV. Provider business mailing address

17025 VIA PIEDRAS
SAN LORENZO CA
94580-2845
US

V. Phone/Fax

Practice location:
  • Phone: 510-278-3347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: