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Individual

REGINA GARDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
3703 WEST LAKE AVE., GLENVIEW, IL 60026-1223
(847) 998-1188
Mailing address
14815 EDBROOKE AVE., DOLTON, IL 60419
(708) 201-0096

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002636
IL

Other

Enumeration date
10/17/2008
Last updated
10/17/2008
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