Provider Demographics
NPI:1336382423
Name:LARA-GAGLIANO, RAQUEL S (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:S
Last Name:LARA-GAGLIANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:GAGLIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:59 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2145
Mailing Address - Country:US
Mailing Address - Phone:718-987-2427
Mailing Address - Fax:718-987-2427
Practice Address - Street 1:59 BISHOP ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2145
Practice Address - Country:US
Practice Address - Phone:718-987-2427
Practice Address - Fax:718-987-2427
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005140-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist