Provider Demographics
NPI:1952859902
Name:SEILER, GABRIELLE KAY
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:KAY
Last Name:SEILER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 HERRICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TEKONSHA
Mailing Address - State:MI
Mailing Address - Zip Code:49092-9667
Mailing Address - Country:US
Mailing Address - Phone:517-677-2231
Mailing Address - Fax:
Practice Address - Street 1:537 HERRICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:TEKONSHA
Practice Address - State:MI
Practice Address - Zip Code:49092-9667
Practice Address - Country:US
Practice Address - Phone:517-677-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS 460 271 461 594225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner