Provider Demographics
NPI:1750916458
Name:GAZZILLO, VICTORIA MARINA (OTR/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARINA
Last Name:GAZZILLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1364
Mailing Address - Country:US
Mailing Address - Phone:973-557-5627
Mailing Address - Fax:
Practice Address - Street 1:27 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-5603
Practice Address - Country:US
Practice Address - Phone:551-247-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00907700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist