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General NPI Number Information
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NPI Number | 1063272730
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Entity Type | Individual
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Provider Name | GABRIELA CEBALLOS
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 75 CRYSTAL RUN RD STE 201
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City | MIDDLETOWN
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State | NY
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Zip | 10941-7010
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Country | US
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Telephone | 845-692-4391
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Fax |
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Provider Business Mailing Address
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Address Line | 815 ROMAN WAY
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City | NEWBURGH
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State | NY
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Zip | 12550-8657
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Country | US
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Telephone | 845-913-6885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 010470
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License Number State | NY
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