Provider Demographics
NPI:1194978189
Name:GABRIEL-GIACOBBE, LISA ANN (OT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:GABRIEL-GIACOBBE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:29 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4003
Mailing Address - Country:US
Mailing Address - Phone:718-447-4714
Mailing Address - Fax:
Practice Address - Street 1:29 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4003
Practice Address - Country:US
Practice Address - Phone:718-447-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006051225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics