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NPI Code Detail

MEDICARE: JUSTINE DISTEL OTD; OTR/L

MEDICARE: JUSTINE DISTEL OTD; 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 Therapist

General Provider Information

NPI Number : 1770307126
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE DISTEL OTD; OTR/L
Provider Business Mailing Address
First Line : 1936 N MOHAWK ST APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60614-5251
Country : US
Telephone Number : 616-826-8245
Fax Number :
Provider Business Practice Location Address
First Line : 1620 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3801
Country : US
Telephone Number : 312-942-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2024
Last Update Date : 01/14/2026

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Directions to “ JUSTINE DISTEL OTD; OTR/L” Practice Location

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