Healthcare Provider Details

I. General information

NPI: 1629239009
Provider Name (Legal Business Name): HARRIET L RYAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST 1006
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST 1006
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2454
  • Fax: 312-563-2222
Mailing address:
  • Phone: 312-563-2454
  • Fax: 312-563-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number056.001835
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.001835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: