Provider Demographics
NPI:1609210855
Name:FEGAN, GINA
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:FEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 CARIBOU LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7825
Mailing Address - Country:US
Mailing Address - Phone:708-460-4645
Mailing Address - Fax:
Practice Address - Street 1:10833 CARIBOU LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7825
Practice Address - Country:US
Practice Address - Phone:708-460-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist