Basic Information
| Provider Information | |||||||||
| NPI: | 1285255778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABBARD | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ETHAN DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGDALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077274200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323303994 | ||||||||
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| Practice Location | |||||||||
| Address1: | 424 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORKED RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087314654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099713500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 05/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00928300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.