Healthcare Provider Details

I. General information

NPI: 1679411680
Provider Name (Legal Business Name): MATTHEW CONLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 440
CHICAGO IL
60612-3836
US

IV. Provider business mailing address

1725 W HARRISON ST STE 440
CHICAGO IL
60612-3836
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.026989
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: