Provider Demographics
NPI:1952890188
Name:GORDILLO, DANIELA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:GORDILLO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 ADEE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5117
Mailing Address - Country:US
Mailing Address - Phone:929-385-4299
Mailing Address - Fax:646-395-3823
Practice Address - Street 1:1055 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2306
Practice Address - Country:US
Practice Address - Phone:929-385-4299
Practice Address - Fax:646-395-3823
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist