Healthcare Provider Details

I. General information

NPI: 1285547281
Provider Name (Legal Business Name): BROOKE ELIZABETH GERLACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGH ST
CARROLL OH
43112-9018
US

IV. Provider business mailing address

55 HIGH ST
CARROLL OH
43112-9018
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: