Provider Demographics
NPI:1881948453
Name:NUSSBAUM, GABRIELLA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROOKFALL RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2947
Mailing Address - Country:US
Mailing Address - Phone:732-777-0193
Mailing Address - Fax:
Practice Address - Street 1:10 BROOKFALL RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2947
Practice Address - Country:US
Practice Address - Phone:732-777-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00596500225X00000X
NY017656-1225X00000X
MD07021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist