Provider Demographics
NPI:1720132830
Name:GERLACH, TARA MICHELLE (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MICHELLE
Last Name:GERLACH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1762
Mailing Address - Country:US
Mailing Address - Phone:740-591-3091
Mailing Address - Fax:
Practice Address - Street 1:218 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674-3100
Practice Address - Country:US
Practice Address - Phone:740-245-7299
Practice Address - Fax:740-245-7555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-16582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer