Provider Demographics
NPI:1508217845
Name:BILELLO, GABRIEL (COTA)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BILELLO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BOGAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4517
Mailing Address - Country:US
Mailing Address - Phone:225-266-4782
Mailing Address - Fax:
Practice Address - Street 1:2727 BOGAN CREEK DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4517
Practice Address - Country:US
Practice Address - Phone:225-266-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0000768224Z00000X
GAOTA001907224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant