Provider Demographics
NPI:1497907877
Name:GERSTUNG, SHERRIE NICHOLE (COTA)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:NICHOLE
Last Name:GERSTUNG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N SHORELINE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6677
Mailing Address - Country:US
Mailing Address - Phone:907-376-6363
Mailing Address - Fax:907-376-6366
Practice Address - Street 1:650 N SHORELINE DR STE 101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6677
Practice Address - Country:US
Practice Address - Phone:907-376-6363
Practice Address - Fax:907-376-6366
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1250224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant