Provider Demographics
NPI:1790428761
Name:MIHALE, GABRIELLA DIANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:DIANNA
Last Name:MIHALE
Suffix:
Gender:F
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 1:2925 OAK CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3422
Mailing Address - Country:US
Mailing Address - Phone:516-316-7883
Mailing Address - Fax:
Practice Address - Street 1:2925 OAK CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3422
Practice Address - Country:US
Practice Address - Phone:516-316-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026690-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist