Individual
BRIELLE THERESA MCGULLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
85 W MAIN ST STE 202, BAY SHORE, NY 11706-8345
(631) 206-3130
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5859
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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