Individual
GABRIELLE COLLETTE FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0178
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0178
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
122213
TX
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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