Healthcare Provider Details

I. General information

NPI: 1659808913
Provider Name (Legal Business Name): CHRISTINE MARIE HULSE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 N WHIPPLE ST
CHICAGO IL
60659-3709
US

IV. Provider business mailing address

5830 N WHIPPLE ST
CHICAGO IL
60659-3709
US

V. Phone/Fax

Practice location:
  • Phone: 773-706-3977
  • Fax:
Mailing address:
  • Phone: 773-706-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056009835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: