Healthcare Provider Details

I. General information

NPI: 1225103658
Provider Name (Legal Business Name): DONNA JEAN ZINE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GRAND AVE
AURORA IL
60506-3007
US

IV. Provider business mailing address

725 GRAND AVE
AURORA IL
60506-3007
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-1110
  • Fax: 630-264-6906
Mailing address:
  • Phone: 630-844-1110
  • Fax: 630-264-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: