Provider Demographics
NPI:1649739103
Name:OREM, GABRIEL DOUGLAS (OTR/L)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:DOUGLAS
Last Name:OREM
Suffix:
Gender:M
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 1:1401 CIRCLE TERRACE BLVD NE APT 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2645
Mailing Address - Country:US
Mailing Address - Phone:815-222-5831
Mailing Address - Fax:
Practice Address - Street 1:10653 WAYSATA BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-224-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105883225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist