Basic Information
| Provider Information | |||||||||
| NPI: | 1528277712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAUNT | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307593251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 N WALNUT ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199631244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024226670 | ||||||||
| FaxNumber: | 3024226550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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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 | 225XH1200X | U1-0000819 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 11750416 | 01 | CAQH | OTHER | 3535011000 | 01 | IBC AMERIHEALTH | OTHER | P01084205 | 01 | DE | MEDICARE RAILROAD | OTHER | 1528277712 | 05 | DE | MEDICAID | 1528277712 | 01 | CHAMPUS TRICARE | OTHER |