Provider Demographics
NPI:1912492190
Name:JOHN, GABRIEL O (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:O
Last Name:JOHN
Suffix:
Gender:M
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 1:7217 CARVED STONE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5249
Mailing Address - Country:US
Mailing Address - Phone:301-852-4680
Mailing Address - Fax:
Practice Address - Street 1:7217 CARVED STONE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5249
Practice Address - Country:US
Practice Address - Phone:018-524-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist