Provider Demographics
NPI:1013126309
Name:GARDNER, CAROL LYNN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:GARDNER
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 1:450 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1919
Mailing Address - Country:US
Mailing Address - Phone:847-842-4418
Mailing Address - Fax:
Practice Address - Street 1:450 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1919
Practice Address - Country:US
Practice Address - Phone:847-842-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002813L225XH1200X
IL056.009274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand