Healthcare Provider Details

I. General information

NPI: 1740849009
Provider Name (Legal Business Name): IRENE OKADA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MICHIGAN AVE
CHICAGO IL
60611-2252
US

IV. Provider business mailing address

733 BARAT CT
LAKE FOREST IL
60045-3133
US

V. Phone/Fax

Practice location:
  • Phone: 312-878-8800
  • Fax:
Mailing address:
  • Phone: 847-615-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070019520
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: