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General NPI Number Information
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NPI Number | 1407222144
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Entity Type | Individual
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Provider Name | REILLY GLEFKE
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 5835 E NORTH PRAIRIE DR
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City | MORRIS
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State | IL
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Zip | 60450-7308
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Country | US
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Telephone | 815-463-9782
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 E GREENFIELD DR
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City | MORRIS
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State | IL
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Zip | 60450-9799
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Country | US
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Telephone |
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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