Provider Demographics
NPI:1518420470
Name:GASTROW, HAILEY ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:ELIZABETH
Last Name:GASTROW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:ELIZABETH
Other - Last Name:GASTROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1725 S NAPERVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5855
Mailing Address - Country:US
Mailing Address - Phone:815-469-1500
Mailing Address - Fax:
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5805
Practice Address - Country:US
Practice Address - Phone:815-469-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty