Healthcare Provider Details

I. General information

NPI: 1114148095
Provider Name (Legal Business Name): ROSA OBREGON-GRECO OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HUEHL RD BUILDING 14A
NORTHBROOK IL
60062-2319
US

IV. Provider business mailing address

425 HUEHL RD BUILDING 14A
NORTHBROOK IL
60062-2319
US

V. Phone/Fax

Practice location:
  • Phone: 847-412-9772
  • Fax: 847-412-9773
Mailing address:
  • Phone: 847-412-9772
  • Fax: 847-412-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: