Healthcare Provider Details

I. General information

NPI: 1154053361
Provider Name (Legal Business Name): OLIVIA BUENO OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 IL ROUTE 22 SUITE 1
FOX RIVER GROVE IL
60021-1339
US

IV. Provider business mailing address

1009 IL ROUTE 22 SUITE 1
FOX RIVER GROVE IL
60021
US

V. Phone/Fax

Practice location:
  • Phone: 847-462-8707
  • Fax: 847-462-9208
Mailing address:
  • Phone: 847-462-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056012242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: