Provider Demographics
NPI:1831377365
Name:PERSIKE, GERALD ALAN JR (COTA)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ALAN
Last Name:PERSIKE
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2730 W RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-4814
Mailing Address - Country:US
Mailing Address - Phone:414-282-2600
Mailing Address - Fax:414-282-2051
Practice Address - Street 1:2730 W RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-4814
Practice Address - Country:US
Practice Address - Phone:414-282-2600
Practice Address - Fax:414-282-2051
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2013-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4789-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant