MEDICARE: COLLEEN BRIANA GASKIN MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XG0600X	Gerontology Occupational Therapist

General Provider Information

NPI Number	:	1417771098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN BRIANA GASKIN MS, OTR/L

Provider Business Mailing Address
First Line	:	817 HARRIAD DR W
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-1207
Country	:	US
Telephone Number	:	516-673-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 FOREST AVE
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2107
Country	:	US
Telephone Number	:	516-656-0575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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