Healthcare Provider Details

I. General information

NPI: 1982961413
Provider Name (Legal Business Name): ELIZABETH ANN WOODIN MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 04/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 75TH ST
AURORA IL
60504-7925
US

IV. Provider business mailing address

1266 SEABURY CIR
CAROL STREAM IL
60188-6027
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-7000
  • Fax:
Mailing address:
  • Phone: 630-823-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056008227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: