Healthcare Provider Details

I. General information

NPI: 1134044019
Provider Name (Legal Business Name): OCTAVIA SHANTA PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 W 85TH PL
CHICAGO IL
60652-3821
US

IV. Provider business mailing address

2817 W 85TH PL
CHICAGO IL
60652-3821
US

V. Phone/Fax

Practice location:
  • Phone: 773-870-2262
  • Fax:
Mailing address:
  • Phone: 773-870-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: