MEDICARE: JEAN M GEBHARDT OTR/L

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	000636	GA

General Provider Information

NPI Number	:	1265424857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M GEBHARDT OTR/L

Provider Business Mailing Address
First Line	:	2016 CAMERON DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-2081
Country	:	US
Telephone Number	:	229-888-8350
Fax Number	:	229-888-8350

Provider Business Practice Location Address
First Line	:	709 N WESTOVER BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-1405
Country	:	US
Telephone Number	:	229-446-2333
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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