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General NPI Number Information
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NPI Number | 1104969211
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Entity Type | Organization
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Legal Business Name | DIANE GASSIRARO PC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1303 GERBER WOODS DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-659-0959
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Fax | 618-655-0995
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Provider Business Mailing Address
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Address Line | 1303 GERBER WOODS DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-659-0959
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Fax | 618-655-0995
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Authorized Official
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Title or Position | REGISTERED OCCUPATIONAL THERAPIST
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Name | MRS. DIANE MARIE GASSIRARO
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Credential | OTRL
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Telephone | 618-659-0959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003239
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IL
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