Healthcare Provider Details

I. General information

NPI: 1255572483
Provider Name (Legal Business Name): PRABHA PATEL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST 65TH ST AT LAKE MICHIGAN
CHICAGO IL
60649-1395
US

IV. Provider business mailing address

1069 W 14TH PL UNIT 326
CHICAGO IL
60608-2079
US

V. Phone/Fax

Practice location:
  • Phone: 773-363-6700
  • Fax:
Mailing address:
  • Phone: 312-242-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.008546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: