Basic Information
| Provider Information | |||||||||
| NPI: | 1083096754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAGLIONE | ||||||||
| FirstName: | SARAH | ||||||||
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| OtherLastName: | GAGLIONE | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | LOREN | ||||||||
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| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 505 PERRY RD | ||||||||
| Address2: | |||||||||
| City: | WOODBINE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082709633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094253740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 E EVESHAM RD | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080439547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567511600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00698000 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.