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Individual

STACEY LYNN GISHEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
904 LEE BLVD, UNIT 106, LEHIGH ACRES, FL 33936-4953
(239) 674-9374
(239) 491-3057
Mailing address
904 LEE BLVD, UNIT 106, LEHIGH ACRES, FL 33936-4953
(239) 674-9374
(239) 491-3057

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15374
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006236000
FL
Enumeration date
07/14/2016
Last updated
07/14/2016
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