Individual
GABRIELLE CELESTE STICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
526 W GRANT AVE, CHARLESTON, IL 61920-3222
(217) 377-5803
Mailing address
526 W GRANT AVE, CHARLESTON, IL 61920-3222
(217) 377-5803
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057.004992
IL
225X00000X
Occupational Therapist
Primary
056.016329
IL
Other
Enumeration date
07/31/2018
Last updated
11/04/2025
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