Provider Demographics
NPI:1609408277
Name:NECESARIO, JEAN-TOM GABRIEL
Entity Type:Individual
Prefix:
First Name:JEAN-TOM GABRIEL
Middle Name:
Last Name:NECESARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 VICTORY GALLOP CT
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2596
Mailing Address - Country:US
Mailing Address - Phone:443-655-6926
Mailing Address - Fax:
Practice Address - Street 1:314 VICTORY GALLOP CT
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2596
Practice Address - Country:US
Practice Address - Phone:443-655-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist