Healthcare Provider Details

I. General information

NPI: 1326757493
Provider Name (Legal Business Name): DINA N VATCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NORTH BLVD
OAK PARK IL
60301-1351
US

IV. Provider business mailing address

1344 N WOLCOTT AVE APT 1
CHICAGO IL
60622-6397
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-2343
  • Fax:
Mailing address:
  • Phone: 202-360-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056008813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: