Provider Demographics
NPI:1609560952
Name:GEHRIG, JORDAN ALEECE (COTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEECE
Last Name:GEHRIG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 N TOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-9782
Mailing Address - Country:US
Mailing Address - Phone:309-863-0601
Mailing Address - Fax:
Practice Address - Street 1:117 S I ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1544
Practice Address - Country:US
Practice Address - Phone:309-734-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057006017224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant