Healthcare Provider Details

I. General information

NPI: 1376969634
Provider Name (Legal Business Name): AMELIA HUTNICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 N TROY ST
CHICAGO IL
60625-4221
US

IV. Provider business mailing address

5129 N TROY ST
CHICAGO IL
60625-4221
US

V. Phone/Fax

Practice location:
  • Phone: 773-583-6636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.010469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: