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General NPI Number Information
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NPI Number | 1366502130
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Entity Type | Individual
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Provider Name | LAURIE A GACKI OTR
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5658 S NEWLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60638
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Country | US
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Telephone | 708-805-2400
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Fax | 773-788-1096
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Provider Business Mailing Address
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Address Line | 5658 S NEWLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60638
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Country | US
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Telephone | 708-805-2400
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Fax | 773-788-1096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IL
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