Provider Demographics
NPI:1225239981
Name:REINA, GLORIA PATRICIA (OTR-L)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:PATRICIA
Last Name:REINA
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 1:3543 W 38TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-3315
Mailing Address - Country:US
Mailing Address - Phone:773-376-5937
Mailing Address - Fax:
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:SUITE 2190
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1876
Practice Address - Country:US
Practice Address - Phone:708-488-1700
Practice Address - Fax:708-488-2391
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist