Provider Demographics
NPI:1861639023
Name:COMMUNITY OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:COMMUNITY OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:GEMBARA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:773-710-3373
Mailing Address - Street 1:11025 S. MASON
Mailing Address - Street 2:
Mailing Address - City:CHGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2237
Mailing Address - Country:US
Mailing Address - Phone:773-710-3373
Mailing Address - Fax:708-422-5205
Practice Address - Street 1:3000 S. PULASKI RD.
Practice Address - Street 2:
Practice Address - City:CHGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-710-3373
Practice Address - Fax:708-422-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty