Provider Demographics
NPI:1871164400
Name:DIZON, GABRIELLE ANDREA (OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANDREA
Last Name:DIZON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1310
Mailing Address - Country:US
Mailing Address - Phone:203-606-6118
Mailing Address - Fax:
Practice Address - Street 1:1214 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4033
Practice Address - Country:US
Practice Address - Phone:505-426-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics