Provider Demographics
NPI:1619272408
Name:HOERTNAGL-PEREIRA, GERTRUD ELISABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GERTRUD
Middle Name:ELISABETH
Last Name:HOERTNAGL-PEREIRA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 ROSES GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-2034
Mailing Address - Country:US
Mailing Address - Phone:631-726-5352
Mailing Address - Fax:
Practice Address - Street 1:262 ROSES GROVE RD
Practice Address - Street 2:
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976-2034
Practice Address - Country:US
Practice Address - Phone:631-726-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8031-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics