Healthcare Provider Details

I. General information

NPI: 1922238138
Provider Name (Legal Business Name): CARMEN E AGUIRRE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CARILLON DR
BARTLETT IL
60103-5300
US

IV. Provider business mailing address

605 SHEFFIELD CIR
SUGAR GROVE IL
60554-9371
US

V. Phone/Fax

Practice location:
  • Phone: 630-483-4735
  • Fax:
Mailing address:
  • Phone: 630-466-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056007333
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number056007333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: