Provider Demographics
NPI:1821124371
Name:GANDHI, AMI (OTR L)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:
Last Name:GANDHI
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 1:1880 BONNIE LN APT 417
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1040
Mailing Address - Country:US
Mailing Address - Phone:847-882-8944
Mailing Address - Fax:847-882-8944
Practice Address - Street 1:824 S MAIN ST
Practice Address - Street 2:STE. 104
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6265
Practice Address - Country:US
Practice Address - Phone:847-571-4669
Practice Address - Fax:815-788-0087
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist