Provider Demographics
NPI:1407354079
Name:GERAK, HEATHER A
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:GERAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 COLLAR PRICE RD SE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403-9777
Mailing Address - Country:US
Mailing Address - Phone:330-599-8345
Mailing Address - Fax:
Practice Address - Street 1:841 COLLAR PRICE RD SE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9777
Practice Address - Country:US
Practice Address - Phone:330-599-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM6702590171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor