Individual
MS. DIANE LAVERNE GILBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6700 S KEATING AVE, CHICAGO, IL 60629-5660
(773) 284-5637
Mailing address
612 RIDGEFIELD RD, NEW LENOX, IL 60451-3340
(708) 548-7405
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
057.001903
IL
224Z00000X
Occupational Therapy Assistant
Primary
057001903
IL
Other
Enumeration date
12/16/2012
Last updated
10/28/2013
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