Provider Demographics
NPI:1508135161
Name:CHURCH, GERALDINE (BS)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:3854 PEORIA RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9591
Mailing Address - Country:US
Mailing Address - Phone:828-964-1903
Mailing Address - Fax:
Practice Address - Street 1:3854 PEORIA RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:NC
Practice Address - Zip Code:28679-9591
Practice Address - Country:US
Practice Address - Phone:828-964-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist