Healthcare Provider Details

I. General information

NPI: 1598574758
Provider Name (Legal Business Name): ASHLEY STOTTS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 N ELSTON AVE
CHICAGO IL
60618-5811
US

IV. Provider business mailing address

2504 CANFIELD CT
NAPERVILLE IL
60564-5840
US

V. Phone/Fax

Practice location:
  • Phone: 312-773-0883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: