Traci A Gerner, O.T.R./L
Individual provider Active NPI Specialist · Johnsburg, IL
NPI 1265610489 · NPPES record last updated Feb 11, 2008
Key facts
- NPI
- 1265610489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 1915 Bison LN
Johnsburg, IL 60051-5243 - Phone
- (815) 578-1715
- NPI assigned
- Feb 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.007219 | IL | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | IL | Yes |
Addresses
Primary practice location
1915 Bison LN
Johnsburg, IL 60051-5243
Mailing address
1915 Bison LN
Johnsburg, IL 60051-5243
Phone (815) 578-1715
Other providers in Johnsburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.