Healthcare Provider Details

I. General information

NPI: 1336271261
Provider Name (Legal Business Name): ANNMARIE HOTARY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 N DAMEN AVE APT A
CHICAGO IL
60625-3558
US

IV. Provider business mailing address

5127 N DAMEN AVE APT A
CHICAGO IL
60625-3558
US

V. Phone/Fax

Practice location:
  • Phone: 773-294-0790
  • Fax: 774-944-5784
Mailing address:
  • Phone: 773-294-0790
  • Fax: 774-944-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056004424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: