Provider Demographics
NPI:1114704954
Name:BRISKER, GRETCHEN NICOLE (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:NICOLE
Last Name:BRISKER
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:NICOLE
Other - Last Name:FORSHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 ROTHROCK LOOP
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 ROTHROCK LOOP
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1331
Practice Address - Country:US
Practice Address - Phone:330-666-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist