Provider Demographics
NPI:1003403924
Name:FORGET ME NOT OT LLC
Entity Type:Organization
Organization Name:FORGET ME NOT OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MT, OTR/L
Authorized Official - Phone:907-317-5545
Mailing Address - Street 1:1048 W INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1077
Mailing Address - Country:US
Mailing Address - Phone:907-317-5545
Mailing Address - Fax:907-865-2499
Practice Address - Street 1:1048 W INTERNATIONAL AIRPORT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1077
Practice Address - Country:US
Practice Address - Phone:907-317-5545
Practice Address - Fax:907-865-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty