Provider Demographics
NPI:1497315519
Name:DELGADO, GABRIELA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MARIE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 SKINNER MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1968
Mailing Address - Country:US
Mailing Address - Phone:706-522-4222
Mailing Address - Fax:706-256-8054
Practice Address - Street 1:3104 SKINNER MILL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1968
Practice Address - Country:US
Practice Address - Phone:706-522-4222
Practice Address - Fax:706-256-8054
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty