Healthcare Provider Details

I. General information

NPI: 1467793109
Provider Name (Legal Business Name): STEPHANIE BIZIAREK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 STONEHAVEN CIR
AURORA IL
60504-8409
US

IV. Provider business mailing address

133 PATRICK AVE
WILLOW SPRINGS IL
60480-1638
US

V. Phone/Fax

Practice location:
  • Phone: 708-715-2555
  • Fax: 630-429-9411
Mailing address:
  • Phone: 630-310-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.010051
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number056.010051
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: