Healthcare Provider Details

I. General information

NPI: 1194865295
Provider Name (Legal Business Name): GLORIA T CHURRY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 US HIGHWAY 41 UNIT A 20
SCHERERVILLE IN
46375-1321
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 219-322-5560
  • Fax: 219-322-1549
Mailing address:
  • Phone: 803-812-3656
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31100138A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: