Healthcare Provider Details

I. General information

NPI: 1215058854
Provider Name (Legal Business Name): RENEE WEIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 W IRVING PARK RD STE 300
CHICAGO IL
60641-2808
US

IV. Provider business mailing address

4445 W IRVING PARK RD STE 300
CHICAGO IL
60641-2808
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 630-933-1550
Mailing address:
  • Phone: 630-933-1500
  • Fax: 630-933-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-006786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: