Provider Demographics
NPI:1568602316
Name:MORALES, GAYLA M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:M
Last Name:MORALES
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 1:7505 BROWN AVE
Mailing Address - Street 2:#2G
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3313
Mailing Address - Country:US
Mailing Address - Phone:708-488-8929
Mailing Address - Fax:
Practice Address - Street 1:420 THATCHER AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1623
Practice Address - Country:US
Practice Address - Phone:708-427-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist