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General NPI Number Information
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NPI Number | 1093295842
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Entity Type | Individual
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Provider Name | MADISON NICOLE GERSZEWSKI OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 5100 MIDWAY DR
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City | TEMPLE
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State | TX
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Zip | 76502-1468
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Country | US
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Telephone | 701-215-1707
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 5TH AVE SE
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City | EAST GRAND FORKS
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State | MN
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Zip | 56721-2314
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Country | US
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Telephone | 701-215-1707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 20560
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License Number State | CA
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