Provider Demographics
NPI:1700091196
Name:WOLF, GESCHE AD (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:GESCHE
Middle Name:AD
Last Name:WOLF
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MRS
Other - First Name:GESCHE
Other - Middle Name:AD
Other - Last Name:ROTHBARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3108 SWAN LANE
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695
Mailing Address - Country:US
Mailing Address - Phone:727-481-0486
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVE N
Practice Address - Street 2:SUITE 100 LAMPERTS HOME THERAPY INC
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8593225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887271600Medicaid