Analiza Gamboa Fajardo
Occupational Therapist - Gerontology
505 College Ave
Ottawa
, Illinois 61350-3865
Analiza Gamboa Fajardo
Occupational Therapist - Gerontology
505 College Ave
Ottawa
, Illinois 61350-3865
(205) 572-0658
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About
Features
Specialties
- Occupational Therapist - Gerontology
Languages spoken
- English
Location
First Address
- Analiza Gamboa Fajardo
- 1920 Old Springville Rd Suite 104
- Birmingham, AL
- Zip : 35215-5858
- Phone : (205) 572-0658
Second Address
- Analiza Gamboa Fajardo
- 505 College Ave
- Ottawa, IL
- Zip : 61350-3865
- Phone : (815) 433-1130
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225XG0600X | Occupational Therapist - Gerontology | 056.008331 | IL |
National Provider Identifier
| NPI | 1659514560 |
|---|---|
| Provider Name | Analiza Gamboa Fajardo |
| First Address | Birmingham, AL 35215-5858 |
| Second Address | Ottawa, IL 61350-3865 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/04/2009 |
| Last Update Date | 08/04/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.