Provider Demographics
NPI:1215661905
Name:GEBHART, MIKLYNN HANNA (OTR/L)
Entity type:Individual
Prefix:
First Name:MIKLYNN
Middle Name:HANNA
Last Name:GEBHART
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-4528
Mailing Address - Country:US
Mailing Address - Phone:229-469-6932
Mailing Address - Fax:229-469-6933
Practice Address - Street 1:809 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4528
Practice Address - Country:US
Practice Address - Phone:229-469-6932
Practice Address - Fax:229-469-6933
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist