Provider Demographics
NPI:1679953772
Name:GERHART, PATRICIA (COTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GERHART
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 STATE ROUTE 44 S
Mailing Address - Street 2:
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-4331
Mailing Address - Country:US
Mailing Address - Phone:814-697-7760
Mailing Address - Fax:
Practice Address - Street 1:156 HARVEY RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-7449
Practice Address - Country:US
Practice Address - Phone:603-296-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008166172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker