Healthcare Provider Details

I. General information

NPI: 1366881898
Provider Name (Legal Business Name): AGNIESZKA CIONCZYK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MENARD AVE
MORTON GROVE IL
60053-3052
US

IV. Provider business mailing address

8701 MENARD AVE
MORTON GROVE IL
60053-3052
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: