Provider Demographics
NPI:1881003572
Name:GELDERT, ROBERT III (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GELDERT
Suffix:III
Gender:M
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 1:473 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2072
Mailing Address - Country:US
Mailing Address - Phone:618-830-2666
Mailing Address - Fax:
Practice Address - Street 1:473 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2072
Practice Address - Country:US
Practice Address - Phone:618-830-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005944225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist