Provider Demographics
NPI:1982092623
Name:GERSTENKORN, BRUCE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:GERSTENKORN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1438
Mailing Address - Country:US
Mailing Address - Phone:805-474-1274
Mailing Address - Fax:
Practice Address - Street 1:14900 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6417
Practice Address - Country:US
Practice Address - Phone:805-466-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist