Provider Demographics
NPI:1124168976
Name:GABBIDON, CHARMAINE MARCIA (OT)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:MARCIA
Last Name:GABBIDON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2925
Mailing Address - Country:US
Mailing Address - Phone:516-285-8192
Mailing Address - Fax:
Practice Address - Street 1:330 W 34TH ST FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2406
Practice Address - Country:US
Practice Address - Phone:212-947-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist