Organization
DIANE GASSIRARO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE MARIE GASSIRARO OTRL (REGISTERED OCCUPATIONAL THERAPIST)
(618) 659-0959
Entity
Organization
Contact information
Practice address
1303 GERBER WOODS DR, EDWARDSVILLE, IL 62025
(618) 659-0959
(618) 655-0995
Mailing address
1303 GERBER WOODS DR, EDWARDSVILLE, IL 62025
(618) 659-0959
(618) 655-0995
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
003239
MO
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
IL
05
—
496740634001
—
IL
Enumeration date
02/15/2007
Last updated
08/22/2020
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