Provider Demographics
NPI:1528207016
Name:PELEHAC, GINA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:PELEHAC
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 1:1709 STRATH ERIN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3838
Mailing Address - Country:US
Mailing Address - Phone:478-533-3713
Mailing Address - Fax:
Practice Address - Street 1:1709 STRATH ERIN RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3838
Practice Address - Country:US
Practice Address - Phone:847-533-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2552225X00000X
WV1395225X00000X
SC3533225X00000X
IL056.008794225X00000X
MA10058225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist