MEDICARE: MS. JULIE PARK GEHRKE OTR

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	64	NC

General Provider Information

NPI Number	:	1164414082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE PARK GEHRKE OTR

Provider Business Mailing Address
First Line	:	7000 SHANNON WILLOW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	704-927-7300
Fax Number	:	704-927-7301

Provider Business Practice Location Address
First Line	:	7000 SHANNON WILLOW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	704-927-7300
Fax Number	:	704-927-7301

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	09/29/2009

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