Healthcare Provider Details

I. General information

NPI: 1689293920
Provider Name (Legal Business Name): ROSE D DUFFY OTR/L, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8157 N OSCEOLA AVE
NILES IL
60714-2947
US

IV. Provider business mailing address

8157 N OSCEOLA AVE
NILES IL
60714-2947
US

V. Phone/Fax

Practice location:
  • Phone: 815-529-8756
  • Fax:
Mailing address:
  • Phone: 815-529-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056009138
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: