Provider Demographics
NPI:1801420740
Name:GIGLI, JACK (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:GIGLI
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2401
Mailing Address - Country:US
Mailing Address - Phone:914-760-2383
Mailing Address - Fax:
Practice Address - Street 1:15 MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2401
Practice Address - Country:US
Practice Address - Phone:914-760-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004085225X00000X
NY018028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist