Individual
JESSICA RENAE GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
900 S RAND RD, LAKE ZURICH, IL 60047-2450
(847) 726-1200
Mailing address
21 OAK PARK DR W, CENTRALIA, IL 62801-5706
(618) 780-5372
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003437
IL
Other
Enumeration date
03/27/2014
Last updated
03/13/2017
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