Provider Demographics
NPI:1962384867
Name:OVERDORF, GABRIELLE ALEXIS
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXIS
Last Name:OVERDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:BELLOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3336
Mailing Address - Country:US
Mailing Address - Phone:570-494-6136
Mailing Address - Fax:
Practice Address - Street 1:50 PLEASANT ST STE 1
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2244
Practice Address - Country:US
Practice Address - Phone:860-222-3122
Practice Address - Fax:860-222-8481
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6707225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics