Provider Demographics
NPI:1083989917
Name:FELTAULT, GAIL M (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:FELTAULT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4353
Mailing Address - Country:US
Mailing Address - Phone:630-881-5345
Mailing Address - Fax:
Practice Address - Street 1:1263 TRINITY DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-4353
Practice Address - Country:US
Practice Address - Phone:630-881-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist