Provider Demographics
NPI:1891367934
Name:GAUTREAU, GUERRELYNE (ADVANCED CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:GUERRELYNE
Middle Name:
Last Name:GAUTREAU
Suffix:
Gender:F
Credentials:ADVANCED CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8589 188TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1162
Mailing Address - Country:US
Mailing Address - Phone:516-993-2781
Mailing Address - Fax:
Practice Address - Street 1:8589 188TH ST FL 2
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1162
Practice Address - Country:US
Practice Address - Phone:516-993-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4379852255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind