Provider Demographics
NPI:1104977263
Name:GALLARDO, GLORIA XIMENA (OT)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:XIMENA
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 W THOMAS ST
Mailing Address - Street 2:FLOOR #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3407
Mailing Address - Country:US
Mailing Address - Phone:773-772-0909
Mailing Address - Fax:
Practice Address - Street 1:2930 S MICHIGAN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3270
Practice Address - Country:US
Practice Address - Phone:312-842-3919
Practice Address - Fax:312-842-3914
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist