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NPI Code Detail

MEDICARE: HAILEY CHASSON OTR/L

MEDICARE:   HAILEY  CHASSON  OTR/L
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
1225X00000XOccupational Therapist056009151IL

General Provider Information

NPI Number : 1679875165
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY CHASSON OTR/L
Provider Business Mailing Address
First Line : 3421 N SEMINARY AVE APT 1N
Second Line : UNIT C
City : CHICAGO
State : IL
Zip : 60657-9036
Country : US
Telephone Number : 773-687-9146
Fax Number :
Provider Business Practice Location Address
First Line : 3421 NORTH SEMINARY AVENUE
Second Line : SUITE 1N
City : CHICAGO
State : IL
Zip : 60657
Country : US
Telephone Number : 312-480-1720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2010
Last Update Date : 10/05/2022

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Directions to “ HAILEY CHASSON OTR/L” Practice Location

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