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NPI Code Detail

MEDICARE: CARISSA GUALANO

MEDICARE: CARISSA GUALANO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-79860IL
2225XP0200XPediatric Occupational Therapist056.015084IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119-749860OTHERILRBT

General Provider Information

NPI Number : 1619526365
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA GUALANO
Provider Business Mailing Address
First Line : 1191 ROHLWING RD SUITE A
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008
Country : US
Telephone Number : 224-248-9449
Fax Number :
Provider Business Practice Location Address
First Line : 1911 ROHLWING RD STE A
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-1397
Country : US
Telephone Number : 224-248-9449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2019
Last Update Date : 05/04/2023

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Directions to “ CARISSA GUALANO ” Practice Location

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