Provider Demographics
NPI:1699819060
Name:AMAN, GERILYN JEAN (OTRL)
Entity Type:Individual
Prefix:
First Name:GERILYN
Middle Name:JEAN
Last Name:AMAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:GERILYN
Other - Middle Name:JEAN
Other - Last Name:HOFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:25989 SW NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-9340
Mailing Address - Country:US
Mailing Address - Phone:541-757-2754
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9621
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR340307225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235118Medicaid