Healthcare Provider Details

I. General information

NPI: 1306919980
Provider Name (Legal Business Name): MRS. NANCY G. OTWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ 142
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ 142
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-2880
  • Fax:
Mailing address:
  • Phone: 773-327-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: