Healthcare Provider Details

I. General information

NPI: 1124137880
Provider Name (Legal Business Name): CHARLES DAVID STAPINSKI OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 E HYDE PARK BLVD
CHICAGO IL
60615-3039
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-1475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: