Provider Demographics
NPI:1144918483
Name:VANWINGERDEN, GABRIELA PAOLA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:PAOLA
Last Name:VANWINGERDEN
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 1:118 POPLARVILLE DR.
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-9844
Mailing Address - Country:US
Mailing Address - Phone:813-451-0135
Mailing Address - Fax:
Practice Address - Street 1:5901 OURAY RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-836-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-05-18
Deactivation Date:2023-05-01
Deactivation Code:
Reactivation Date:2023-05-17
Provider Licenses
StateLicense IDTaxonomies
SC5850224Z00000X
NMOT-2023-0141224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant