Healthcare Provider Details

I. General information

NPI: 1437868932
Provider Name (Legal Business Name): KRISTIN MARIE GELLERT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 3RD ST STE 102
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

912 3RD ST STE 102
GREENSBORO NC
27405-6967
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-2054
  • Fax: 336-271-2058
Mailing address:
  • Phone: 336-271-2054
  • Fax: 336-271-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3498
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number3498
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: