Healthcare Provider Details

I. General information

NPI: 1689094393
Provider Name (Legal Business Name): GABRIELLE GEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 MAIN ST
WORCESTER MA
01608-1893
US

IV. Provider business mailing address

484 MAIN ST
WORCESTER MA
01608-1893
US

V. Phone/Fax

Practice location:
  • Phone: 508-751-6322
  • Fax:
Mailing address:
  • Phone: 508-751-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10601
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: