Healthcare Provider Details

I. General information

NPI: 1568604882
Provider Name (Legal Business Name): GILBERT FRANCIS PORSOVIGAN OTR / L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 ASHBROOK LN
PLAINFIELD IL
60586-5647
US

IV. Provider business mailing address

7310 ASHBROOK LN
PLAINFIELD IL
60586-5647
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-8392
  • Fax:
Mailing address:
  • Phone: 815-254-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056003917
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier056003917
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerOTR / L

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: