Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056.006539 | IL |
NPI | 1093822942 |
---|---|
Provider Name | Jeffrey Scott Gaich |
First Address | Hazel Crest, IL 60429-1451 |
Second Address | Hazel Crest, IL 60429-1451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |