Provider Demographics
NPI:1639269277
Name:GERSTENFELD, PAUL S (MS, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:GERSTENFELD
Suffix:
Gender:M
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 14TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1752
Mailing Address - Country:US
Mailing Address - Phone:619-417-2187
Mailing Address - Fax:
Practice Address - Street 1:147 BAY ST UNIT 21
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1076
Practice Address - Country:US
Practice Address - Phone:310-396-8565
Practice Address - Fax:310-396-0052
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X, 225XE1200X, 225XH1200X, 225XN1300X
CAOT4713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1059271OtherNBCOT
CAOT4713OtherCBOT
CA1059271OtherNBCOT