Healthcare Provider Details

I. General information

NPI: 1740078732
Provider Name (Legal Business Name): JASMINA BUZALJKO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 JOHNS DR
GLENVIEW IL
60025-1657
US

IV. Provider business mailing address

6340 N CENTRAL PARK AVE
CHICAGO IL
60659-1206
US

V. Phone/Fax

Practice location:
  • Phone: 847-610-9650
  • Fax:
Mailing address:
  • Phone: 773-966-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: