Provider Demographics
NPI:1164414082
Name:GEHRKE, JULIE PARK (OTR)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:PARK
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SHANNON WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1318
Mailing Address - Country:US
Mailing Address - Phone:704-927-7300
Mailing Address - Fax:704-927-7301
Practice Address - Street 1:7000 SHANNON WILLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1318
Practice Address - Country:US
Practice Address - Phone:704-927-7300
Practice Address - Fax:704-927-7301
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2510695Medicare ID - Type Unspecified