Provider Demographics
NPI:1255348686
Name:GORMAN, KERRI ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ANN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 W MENOMINEE PKWY
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1717
Mailing Address - Country:US
Mailing Address - Phone:708-388-0156
Mailing Address - Fax:
Practice Address - Street 1:6701 W MENOMINEE PKWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1717
Practice Address - Country:US
Practice Address - Phone:708-388-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist