Provider Demographics
NPI:1588183719
Name:HECKMAN, GABRIELLE ELIZABETH (MOT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:ELIZABETH
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SCHAEFER CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3986
Mailing Address - Country:US
Mailing Address - Phone:573-680-6602
Mailing Address - Fax:
Practice Address - Street 1:225 SCHAEFER CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3986
Practice Address - Country:US
Practice Address - Phone:573-680-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist