Provider Demographics
NPI:1770823528
Name:GIERUSZ, JENNIFER (OTRL)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GIERUSZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 E CAYUGA LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1722
Mailing Address - Country:US
Mailing Address - Phone:847-975-9817
Mailing Address - Fax:
Practice Address - Street 1:829 CARILLON DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-5300
Practice Address - Country:US
Practice Address - Phone:630-372-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist