Provider Demographics
NPI:1184936197
Name:LICCIARDELLO, GAIL JEANNE (OT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:JEANNE
Last Name:LICCIARDELLO
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 1:777 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1228
Mailing Address - Country:US
Mailing Address - Phone:603-929-3032
Mailing Address - Fax:603-926-6238
Practice Address - Street 1:777 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1228
Practice Address - Country:US
Practice Address - Phone:603-929-3032
Practice Address - Fax:603-926-6238
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH202225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist