Provider Demographics
NPI:1366084667
Name:GUTIERREZ, JOANNE YUM (OTR/L)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:YUM
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:YUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 S CANAL ST # 1086
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4907
Mailing Address - Country:US
Mailing Address - Phone:312-566-7264
Mailing Address - Fax:
Practice Address - Street 1:1130 S CANAL ST # 1086
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4907
Practice Address - Country:US
Practice Address - Phone:312-566-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056013043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist