Individual
GARY S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
522 MAIN ST, EVANSTON, IL 60202-1815
(474) 751-6308
(847) 475-1631
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009329
IL
225XH1200X
Hand Occupational Therapist
056009329
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056-009329
STATE LICENSE
IL
Enumeration date
05/06/2011
Last updated
05/28/2019
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