Provider Demographics
NPI:1508204199
Name:GREGORY, ANNE KRISTEN (MOT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KRISTEN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 S LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3524
Mailing Address - Country:US
Mailing Address - Phone:630-347-8116
Mailing Address - Fax:
Practice Address - Street 1:5820 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2616
Practice Address - Country:US
Practice Address - Phone:773-685-8482
Practice Address - Fax:773-685-8479
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist