Provider Demographics
NPI:1144476755
Name:BREVIL, MAGALI GISELE
Entity type:Individual
Prefix:
First Name:MAGALI
Middle Name:GISELE
Last Name:BREVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 SW HEATHER ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2454
Mailing Address - Country:US
Mailing Address - Phone:772-878-5914
Mailing Address - Fax:
Practice Address - Street 1:1106 SW HEATHER ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2454
Practice Address - Country:US
Practice Address - Phone:772-878-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 9724224Z00000X
NJ46TAO9066900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant