Provider Demographics
NPI:1104482900
Name:ROMERO, GABRIELLE ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:GLODICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17328 BRACKEN FERN LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-5408
Mailing Address - Country:US
Mailing Address - Phone:810-441-4556
Mailing Address - Fax:
Practice Address - Street 1:17328 BRACKEN FERN LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-5408
Practice Address - Country:US
Practice Address - Phone:810-441-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010516225X00000X
FLOT23749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist