Provider Demographics
NPI:1255672721
Name:JEAN, GERDA L (OT)
Entity Type:Individual
Prefix:
First Name:GERDA
Middle Name:L
Last Name:JEAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2284
Mailing Address - Country:US
Mailing Address - Phone:941-204-0745
Mailing Address - Fax:941-625-3161
Practice Address - Street 1:1311 E OAK ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8902
Practice Address - Country:US
Practice Address - Phone:941-204-0745
Practice Address - Fax:941-625-3161
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist