Provider Demographics
NPI:1801825765
Name:RISER, GRETCHEN M (OTR/L CHT)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:M
Last Name:RISER
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-875-4263
Mailing Address - Fax:217-872-5481
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 215
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-875-4263
Practice Address - Fax:217-872-5481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005433225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00048436OtherRAILROAD MEDICARE
IL05832033OtherBLUE CROSS BLUE SHIELD
IL05832033OtherBLUE CROSS BLUE SHIELD