Provider Demographics
NPI:1578320578
Name:GERVASI, SALEEMA H
Entity Type:Individual
Prefix:
First Name:SALEEMA
Middle Name:H
Last Name:GERVASI
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 1:1318 STONECREST BLVD
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0070
Mailing Address - Country:US
Mailing Address - Phone:718-551-1767
Mailing Address - Fax:
Practice Address - Street 1:1318 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-0070
Practice Address - Country:US
Practice Address - Phone:718-551-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6367225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics