Individual
GARY ALLAN PONCINIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-3651
Mailing address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-3651
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008401
IL
Other
Enumeration date
03/08/2013
Last updated
03/08/2013
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