Provider Demographics
NPI:1417667312
Name:GERBOC, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GERBOC
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 1:13808 EXOTICA LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8120
Mailing Address - Country:US
Mailing Address - Phone:561-301-3376
Mailing Address - Fax:
Practice Address - Street 1:13808 EXOTICA LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8120
Practice Address - Country:US
Practice Address - Phone:561-301-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist