Provider Demographics
NPI:1770779241
Name:GERACI, CORRIN NICOLE (OT)
Entity type:Individual
Prefix:
First Name:CORRIN
Middle Name:NICOLE
Last Name:GERACI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CORRIN
Other - Middle Name:NICOLE
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7575 FIVE MILE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4346
Mailing Address - Country:US
Mailing Address - Phone:513-233-4360
Mailing Address - Fax:513-233-4361
Practice Address - Street 1:7575 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4346
Practice Address - Country:US
Practice Address - Phone:513-233-4360
Practice Address - Fax:513-233-4361
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHO.T.006315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000536411OtherANTHEM
OHP00471206OtherMEDICARE RAILROAD
OH2900070Medicaid
OH0225920002Medicare NSC
OHP00471206OtherMEDICARE RAILROAD