Provider Demographics
NPI:1356608855
Name:GABBARD, TRINA (SLP)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:GABBARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2245
Mailing Address - Country:US
Mailing Address - Phone:864-221-5759
Mailing Address - Fax:864-757-9846
Practice Address - Street 1:203 N MAPLE ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-757-9846
Practice Address - Fax:864-757-9847
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist