Provider Demographics
NPI:1023557980
Name:RICHARDSON, GABRIELLE (OTR)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CAMBER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3384
Mailing Address - Country:US
Mailing Address - Phone:856-904-0484
Mailing Address - Fax:
Practice Address - Street 1:184 CAMBER LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3384
Practice Address - Country:US
Practice Address - Phone:856-904-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist