Individual
AUTUMN GLEICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
7018 SAINT LEOS RD, EVANSVILLE, IL 62242-1602
(618) 580-6541
(888) 388-2143
Mailing address
7018 SAINT LEOS RD, EVANSVILLE, IL 62242-1602
(618) 580-6541
(888) 388-2143
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.009230
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
321867871001
—
IL
Enumeration date
03/22/2011
Last updated
12/06/2016
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