Healthcare Provider Details

I. General information

NPI: 1386288892
Provider Name (Legal Business Name): HANNAH MELNICK MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 PROGRESS DR
GRAYSLAKE IL
60030-1671
US

IV. Provider business mailing address

998 PROGRESS DR
GRAYSLAKE IL
60030-1671
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-3458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056013300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: