Healthcare Provider Details

I. General information

NPI: 1205997400
Provider Name (Legal Business Name): GINA MOTTIER D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N HARLEM AVE
CHICAGO IL
60634-4502
US

IV. Provider business mailing address

3223 N HARLEM AVE
CHICAGO IL
60634-4502
US

V. Phone/Fax

Practice location:
  • Phone: 773-968-9402
  • Fax:
Mailing address:
  • Phone: 773-968-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: