Individual
ILSE G GONGORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
522 W CHESTNUT ST STE GA, HINSDALE, IL 60521-3174
(331) 271-5070
Mailing address
217 BERNICE AVE, NORTHLAKE, IL 60164-1712
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.015867
IL
Other
Enumeration date
01/16/2024
Last updated
01/16/2024
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