Provider Demographics
NPI:1972837946
Name:VIGNEAULT, GLORIA S (OT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:VIGNEAULT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HIBISCUS LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2034
Mailing Address - Country:US
Mailing Address - Phone:772-234-8879
Mailing Address - Fax:
Practice Address - Street 1:715 HIBISCUS LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2034
Practice Address - Country:US
Practice Address - Phone:772-234-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist