Provider Demographics
NPI:1427164110
Name:MCWILLIAMS GERSBACH, LORI S (MOT, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:MCWILLIAMS GERSBACH
Suffix:
Gender:F
Credentials:MOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10641
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-7641
Mailing Address - Country:US
Mailing Address - Phone:432-935-3479
Mailing Address - Fax:
Practice Address - Street 1:3416 W WALL ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6710
Practice Address - Country:US
Practice Address - Phone:432-789-1055
Practice Address - Fax:432-689-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107357225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107357OtherSTATE LICENSE NUMBER
1011842OtherNAT'L CERTIFICATION #