Provider Demographics
NPI:1497898191
Name:REYES, GLADY (OTRL)
Entity Type:Individual
Prefix:
First Name:GLADY
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 STATE ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4735
Mailing Address - Country:US
Mailing Address - Phone:630-408-3822
Mailing Address - Fax:815-313-5283
Practice Address - Street 1:1410 STATE ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4735
Practice Address - Country:US
Practice Address - Phone:630-408-3822
Practice Address - Fax:815-313-5283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL056.002994225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist