Individual provider Active NPI

Diane Laverne Gilbert, COTA/L

  • Occupational Therapy Assistant
  • Chicago, IL
National Provider Identifier
1447596671
Registry record updated Oct 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
057001903 Issued in IL
Practice address
6700 S Keating Ave
Chicago, IL 60629-5660
Phone
(773) 284-5637
NPI assigned
Dec 16, 2012
Last updated
Oct 28, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 057001903 IL Primary
Community Health Worker 172V00000X 057.001903 IL

Addresses

Primary practice location

6700 S Keating Ave
Chicago, IL 60629-5660

Mailing address

612 Ridgefield Rd
New Lenox, IL 60451-3340
Phone (708) 548-7405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
057.001903ILMDCommunity Health Worker
057001903ILMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382918400000",
    "number": "1447596671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 RIDGEFIELD RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604513340",
            "telephone_number": "708-548-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 S KEATING AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606295660",
            "telephone_number": "773-284-5637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBERT",
        "first_name": "DIANE",
        "middle_name": "LAVERNE",
        "name_prefix": "Ms.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-16",
        "last_updated": "2013-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057001903",
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IL",
            "license": "057.001903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.