Organization · NPI-2

4619 N. Ravenswood Ave. Suite 204 Chicago, Il 60640

Occupational Therapy Assistant · Chicago, IL

NPI number1992481246
StatusActive
Last updated in NPPESJun 22, 2023

Details

NPI
1992481246
Entity type
Organization (NPI-2)
Legal business name
4619 N. Ravenswood Ave. Suite 204 Chicago, Il 60640
Organization subpart
No
Enumeration date
Jun 22, 2023
Certification date
Jun 22, 2023
Last updated
Jun 22, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
224Z00000X Occupational Therapy Assistant––Yes

Practice location

4619 N Ravenswood Ave Ste 204
Chicago, IL 60640-4579

Phone 773-697-7333

Mailing address

4619 N Ravenswood Ave Ste 204
Chicago, IL 60640-4579

Authorized official

Maya Elena E Horowitz
Occupational Therapy Assistant
7737974155

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