MEDICARE: KAROLINA TERESA GAWRON OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.015607	IL

General Provider Information

NPI Number	:	1447006507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROLINA TERESA GAWRON OTD, OTR/L

Provider Business Mailing Address
First Line	:	6347 W ROSCOE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4049
Country	:	US
Telephone Number	:	773-987-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 DENNIS LN
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1319
Country	:	US
Telephone Number	:	773-330-9348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2024

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