Provider Demographics
NPI:1205223427
Name:GILMORE, SHAUNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:GILMORE
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 1:5127 N DAMEN AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1992
Mailing Address - Country:US
Mailing Address - Phone:773-294-0790
Mailing Address - Fax:
Practice Address - Street 1:5127 N DAMEN AVE APT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3558
Practice Address - Country:US
Practice Address - Phone:773-294-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007828225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist