Provider Demographics
NPI:1548413826
Name:LIBERG, GAIL A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:LIBERG
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 1:1675 DEMPSTEN ST.
Mailing Address - Street 2:LUTHERAN GENERAL HOSPITAL PEDIATRIC THERAPIES
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:847-723-4540
Practice Address - Street 1:202 59TH ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-1720
Practice Address - Country:US
Practice Address - Phone:847-723-7304
Practice Address - Fax:847-723-4540
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-000241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist