Healthcare Provider Details

I. General information

NPI: 1922886084
Provider Name (Legal Business Name): TAYLOR STAZZONE MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BELMONT LN
CAROL STREAM IL
60188-2467
US

IV. Provider business mailing address

3283 HILLCREST RD
GENEVA IL
60134-4637
US

V. Phone/Fax

Practice location:
  • Phone: 630-523-8972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056015509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: