Healthcare Provider Details

I. General information

NPI: 1417685926
Provider Name (Legal Business Name): CHRISTINE DIANA CANTU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COMMONS DR STE 102
AURORA IL
60504-4155
US

IV. Provider business mailing address

25930 S COURTNEY RD
PLAINFIELD IL
60585-7719
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-1820
  • Fax:
Mailing address:
  • Phone: 708-220-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056002997
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: