Individual
DIANE MARIE GASSIRARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1303 GERBER WOODS DR, EDWARDSVILLE, IL 62025-3102
(618) 659-0959
Mailing address
1303 GERBER WOODS DR, EDWARDSVILLE, IL 62025-3102
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006027820
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/11/2008
Last updated
04/11/2008
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