Provider Demographics
NPI:1760847636
Name:HAY, GERALD WALTER (COTA/L)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WALTER
Last Name:HAY
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12116 W BLUEMOUND RD APT 14
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3862
Mailing Address - Country:US
Mailing Address - Phone:305-281-9866
Mailing Address - Fax:
Practice Address - Street 1:1651 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2950
Practice Address - Country:US
Practice Address - Phone:847-748-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004357224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant