Provider Demographics
NPI:1760121727
Name:GABRIEL, BREANNA MARIE (MSOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:MARIE
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 IBIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1328
Mailing Address - Country:US
Mailing Address - Phone:619-890-4633
Mailing Address - Fax:
Practice Address - Street 1:10760 THORNMINT RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2700
Practice Address - Country:US
Practice Address - Phone:855-426-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23620225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics