Provider Demographics
NPI:1629845813
Name:GERST, JENNIFER PAIGE (DOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAIGE
Last Name:GERST
Suffix:
Gender:F
Credentials:DOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:252-726-1802
Mailing Address - Fax:
Practice Address - Street 1:2145 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-2404
Practice Address - Country:US
Practice Address - Phone:252-726-1802
Practice Address - Fax:252-726-1805
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16425OtherOT LICENSE