Provider Demographics
NPI:1154095198
Name:MAZZEO, GABRIELLA ROSE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROSE
Last Name:MAZZEO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 CHAIN BRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5723
Mailing Address - Country:US
Mailing Address - Phone:908-956-5292
Mailing Address - Fax:
Practice Address - Street 1:1487 CHAIN BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5723
Practice Address - Country:US
Practice Address - Phone:703-637-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT210002246225X00000X
VA0119009520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist