Provider Demographics
NPI:1417771098
Name:GASKIN, COLLEEN BRIANA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:BRIANA
Last Name:GASKIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 HARRIAD DR W
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1207
Mailing Address - Country:US
Mailing Address - Phone:516-673-5553
Mailing Address - Fax:
Practice Address - Street 1:39 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2107
Practice Address - Country:US
Practice Address - Phone:516-656-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology