Healthcare Provider Details

I. General information

NPI: 1194612572
Provider Name (Legal Business Name): TRISTIAN COLETTE GELLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 08/11/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 VIRGINIA BEACH BLVD STE 101
VIRGINIA BEACH VA
23462-5631
US

IV. Provider business mailing address

1912 TUFTON CT
VIRGINIA BEACH VA
23454-6310
US

V. Phone/Fax

Practice location:
  • Phone: 757-455-5000
  • Fax: 757-319-4142
Mailing address:
  • Phone: 757-642-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14126
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004221
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: