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NPI Code Detail

MEDICARE: GAIL HERZOG KESSLER OTA

MEDICARE: GAIL HERZOG KESSLER OTA
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
1224Z00000XOccupational Therapy Assistant4389NC

General Provider Information

NPI Number : 1194929901
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL HERZOG KESSLER OTA
Provider Business Mailing Address
First Line : 339 WINDSOR MANOR WAY
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-4430
Country : US
Telephone Number : 336-996-7093
Fax Number :
Provider Business Practice Location Address
First Line : 6100 W FRIENDLY AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27410-4160
Country : US
Telephone Number : 336-292-1301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2007
Last Update Date : 07/08/2007

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Directions to “ GAIL HERZOG KESSLER OTA” Practice Location

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