Provider Demographics
NPI:1669679791
Name:GEBCZYK, SHERRY R (OTR)
Entity Type:Individual
Prefix:MISS
First Name:SHERRY
Middle Name:R
Last Name:GEBCZYK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOBART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5308
Mailing Address - Country:US
Mailing Address - Phone:315-567-9799
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 ROUTE 90
Practice Address - Street 2:MANDEL THERAPY GROUP
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011432-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist