Healthcare Provider Details

I. General information

NPI: 1265994016
Provider Name (Legal Business Name): SAMANTHA MARIE HOZZIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5172 DEERPATH RD
OAK FOREST IL
60452-4410
US

IV. Provider business mailing address

5172 DEERPATH RD
OAK FOREST IL
60452-4410
US

V. Phone/Fax

Practice location:
  • Phone: 815-218-8623
  • Fax:
Mailing address:
  • Phone: 815-218-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056013000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: