Provider Demographics
NPI:1497401574
Name:PATHAK, GARGIE SANJAY (S/OT)
Entity Type:Individual
Prefix:
First Name:GARGIE
Middle Name:SANJAY
Last Name:PATHAK
Suffix:
Gender:F
Credentials:S/OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 RUTLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5203
Mailing Address - Country:US
Mailing Address - Phone:419-705-6963
Mailing Address - Fax:
Practice Address - Street 1:482 RUTLEDGE CT
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5203
Practice Address - Country:US
Practice Address - Phone:419-705-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant