Basic Information
| Provider Information | |||||||||
| NPI: | 1649514548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERBER | ||||||||
| FirstName: | JOANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 W SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | SOUDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189642054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157232182 | ||||||||
| FaxNumber: | 2157232742 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 W SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | SOUDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189642054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157232182 | ||||||||
| FaxNumber: | 2157232742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP0050998 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.