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Contact Information

4619 N. RAVENSWOOD AVE. SUITE 204 CHICAGO, IL 60640
4619 N RAVENSWOOD AVE STE 204
CHICAGO, IL60640-4579
 Phone: 773-697-7333
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
Indicates primary specialty

NPI Profile & details for 4619 N RAVENSWOOD AVE SUITE 204 CHICAGO IL 60640 · (Female)

NPI Number 1992481246
Status Active
Credentials
Entity Individual
Enumeration date 06/22/2023
Last updated 06/22/2023 - About 3 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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