Healthcare Provider Details

I. General information

NPI: 1790696391
Provider Name (Legal Business Name): ELLEN GILBERT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S ADDISON AVE
VILLA PARK IL
60181-2877
US

IV. Provider business mailing address

1041 BUTTERNUT LN
NORTHBROOK IL
60062-3510
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-4433
  • Fax:
Mailing address:
  • Phone: 224-688-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: