Healthcare Provider Details

I. General information

NPI: 1801523907
Provider Name (Legal Business Name): ALLISON MARIE GRADY OTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2635 CHURCH RD STE 103
AURORA IL
60502-8943
US

IV. Provider business mailing address

2635 CHURCH RD STE 103
AURORA IL
60502-8943
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax:
Mailing address:
  • Phone: 630-933-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.012475
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: