Provider Demographics
NPI:1982650941
Name:GURGEL, THERESA (MS, OTR)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:GURGEL
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:1105 WAUPACA STREET
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-0225
Mailing Address - Country:US
Mailing Address - Phone:920-446-3508
Mailing Address - Fax:
Practice Address - Street 1:1105 WAUPACA ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:WI
Practice Address - Zip Code:54940-9072
Practice Address - Country:US
Practice Address - Phone:920-446-3508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4392-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist