Basic Information
| Provider Information | |||||||||
| NPI: | 1861974461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERACI | ||||||||
| FirstName: | GABRIELA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 ROBINHOOD LN | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605261576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083057795 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2827 FORT MISSOULA RD | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067284100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2018 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTP-OT-LIC-6108 | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.