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General NPI Number Information
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NPI Number | 1497898191
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Entity Type | Individual
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Provider Name | GLADY REYES OTRL
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 1410 STATE ST
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City | OTTAWA
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State | IL
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Zip | 61350-4735
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Country | US
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Telephone | 630-408-3822
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Fax | 815-313-5283
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Provider Business Mailing Address
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Address Line | 1410 STATE ST
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City | OTTAWA
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State | IL
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Zip | 61350-4735
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Country | US
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Telephone | 630-408-3822
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Fax | 815-313-5283
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.002994
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License Number State | IL
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