MEDICARE: SHAUNA GILMORE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056007828	IL

General Provider Information

NPI Number	:	1205223427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA GILMORE OTR/L

Provider Business Mailing Address
First Line	:	5127 N DAMEN AVE
Second Line	:	UNIT A
City	:	CHICAGO
State	:	IL
Zip	:	60625-1992
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	5127 N DAMEN AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3558
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2015
Last Update Date	:	04/26/2015

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