Healthcare Provider Details

I. General information

NPI: 1801000567
Provider Name (Legal Business Name): SUDHIR KUMAR OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 39TH ST SUITE 100
LYONS IL
60534-1247
US

IV. Provider business mailing address

7310 39TH ST SUITE 100
LYONS IL
60534-1247
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-9616
  • Fax: 708-447-9626
Mailing address:
  • Phone: 708-447-9616
  • Fax: 708-447-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: