Provider Demographics
NPI:1407493547
Name:GERLACH, GINA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GERLACH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3053
Mailing Address - Country:US
Mailing Address - Phone:516-719-3735
Mailing Address - Fax:516-365-4748
Practice Address - Street 1:1554 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3053
Practice Address - Country:US
Practice Address - Phone:516-719-3735
Practice Address - Fax:516-365-4748
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020309-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist