Healthcare Provider Details

I. General information

NPI: 1083435200
Provider Name (Legal Business Name): BRIDGET ANN O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 CRESCENT DR STE 101
MOKENA IL
60448-7526
US

IV. Provider business mailing address

15281 RAINTREE DR
ORLAND PARK IL
60462-3802
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.016269
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: