Healthcare Provider Details

I. General information

NPI: 1780692319
Provider Name (Legal Business Name): KRISTY ANNE ZARLEY O.T.R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 W NEWPORT AVE UNIT C
CHICAGO IL
60657-1664
US

IV. Provider business mailing address

1157 W NEWPORT AVE UNIT C
CHICAGO IL
60657-1664
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-6641
  • Fax:
Mailing address:
  • Phone: 773-549-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.004143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: