Provider Demographics
NPI:1508567660
Name:GERLACH, NATASHA NICOLE (OTA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:GERLACH
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-3069
Mailing Address - Country:US
Mailing Address - Phone:361-688-4494
Mailing Address - Fax:
Practice Address - Street 1:801 CANTWELL LN
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-2605
Practice Address - Country:US
Practice Address - Phone:361-400-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19368224Z00000X
TX212811224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant