Basic Information
| Provider Information | |||||||||
| NPI: | 1477788305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASS | ||||||||
| FirstName: | TONYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13491 CO HWY 12 | ||||||||
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| City: | VENEDY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62214 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 NORTH ALTON | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185374401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.007483 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.