Healthcare Provider Details

I. General information

NPI: 1417610510
Provider Name (Legal Business Name): NICOLE ESTHER KOVALEVSKY OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 03/16/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RAYMOND DR STE 14
NORTHBROOK IL
60062-6739
US

IV. Provider business mailing address

2390 EL CID LN
NORTHBROOK IL
60062-7005
US

V. Phone/Fax

Practice location:
  • Phone: 224-216-2488
  • 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: