Healthcare Provider Details

I. General information

NPI: 1366763617
Provider Name (Legal Business Name): HOLLY MARIE GEHRI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 9TH ST
DE PERE WI
54115-1393
US

IV. Provider business mailing address

1610 HAZELWOOD DR
SOBIESKI WI
54171-9775
US

V. Phone/Fax

Practice location:
  • Phone: 920-265-3175
  • Fax:
Mailing address:
  • Phone: 920-265-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2186-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: