Provider Demographics
NPI:1013506708
Name:GERLACH, JENNA (OTR)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GERLACH
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 1:603 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-8235
Mailing Address - Country:US
Mailing Address - Phone:812-259-1675
Mailing Address - Fax:
Practice Address - Street 1:603 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639-8235
Practice Address - Country:US
Practice Address - Phone:812-259-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005323A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist