Provider Demographics
NPI:1811287790
Name:GEMBARA OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:GEMBARA OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-710-3373
Mailing Address - Street 1:4425 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5560
Mailing Address - Country:US
Mailing Address - Phone:773-710-3373
Mailing Address - Fax:
Practice Address - Street 1:11025 MASON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2237
Practice Address - Country:US
Practice Address - Phone:773-710-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006659261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation