1700091196 NPI number — MRS. GESCHE A.D. WOLF OTR L

Table of content: MRS. GESCHE A.D. WOLF OTR L (NPI 1700091196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700091196 NPI number — MRS. GESCHE A.D. WOLF OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
GESCHE
Provider Middle Name:
A.D.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTHBARTH
Provider Other First Name:
GESCHE
Provider Other Middle Name:
A.D.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700091196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3108 SWAN LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAFETY HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-481-0486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8254 118TH AVE N
Provider Second Line Business Practice Location Address:
SUITE 100 LAMPERTS HOME THERAPY INC
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-541-5304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT8593 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 887271600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".