Provider Demographics
NPI:1700916889
Name:GANFIELD MFR THERAPEUTICS LTD
Entity Type:Organization
Organization Name:GANFIELD MFR THERAPEUTICS LTD
Other - Org Name:GANFIELD THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:847-244-7070
Mailing Address - Street 1:1125 N DELANY RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2007
Mailing Address - Country:US
Mailing Address - Phone:847-244-7070
Mailing Address - Fax:847-244-7071
Practice Address - Street 1:1125 N DELANY RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2007
Practice Address - Country:US
Practice Address - Phone:847-244-7070
Practice Address - Fax:847-244-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04926912OtherBCBS OF IL