MEDICARE: CODY GERNATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1588941736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY GERNATT

Provider Business Mailing Address
First Line	:	3749 ROUTE 39
Second Line	:
City	:	COLLINS
State	:	NY
Zip	:	14034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 CYPRESS GARDENS BLVD.
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884
Country	:	US
Telephone Number	:	863-293-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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Directions to “ CODY GERNATT ” Practice Location

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