MEDICARE: GABRIELLA ROSE GAVINELLI

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	225X00000X	Occupational Therapist	026389	NY

General Provider Information

NPI Number	:	1730849084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA ROSE GAVINELLI

Provider Business Mailing Address
First Line	:	211 POTTER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3050
Country	:	US
Telephone Number	:	917-504-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 POTTER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3050
Country	:	US
Telephone Number	:	917-504-7442
Fax Number	:

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

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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