Healthcare Provider Details

I. General information

NPI: 1922730597
Provider Name (Legal Business Name): GINA MARIE HURLBURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-1455
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 847-506-1767
  • Fax: 847-506-9243
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-012706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: