Healthcare Provider Details

I. General information

NPI: 1124870563
Provider Name (Legal Business Name): ALLISON CHASE DAUL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 COMPASS RD STE 100
GLENVIEW IL
60026-8043
US

IV. Provider business mailing address

300 ANTHONY AVE UNIT 208
MUNDELEIN IL
60060-2451
US

V. Phone/Fax

Practice location:
  • Phone: 847-510-5620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056015946
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: