Healthcare Provider Details

I. General information

NPI: 1497619126
Provider Name (Legal Business Name): JOYCE GEBRAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE MIKAEL

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4886 W TAFT RD
LIVERPOOL NY
13088-4810
US

IV. Provider business mailing address

8196 WHITMAN WAY
LIVERPOOL NY
13090-6895
US

V. Phone/Fax

Practice location:
  • Phone: 315-810-2423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: