Provider Demographics
NPI:1417687955
Name:GABRIEL, LUCHEN (OWNER)
Entity Type:Individual
Prefix:
First Name:LUCHEN
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 WHISPERING TRAILS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1808
Mailing Address - Country:US
Mailing Address - Phone:863-604-0892
Mailing Address - Fax:
Practice Address - Street 1:3198 WHISPERING TRAILS AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1808
Practice Address - Country:US
Practice Address - Phone:863-604-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL22000250565.224ZR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility