Healthcare Provider Details

I. General information

NPI: 1790031359
Provider Name (Legal Business Name): LYNDA K STEARN-ELAM COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

1051 W 107TH PL
CHICAGO IL
60643-3717
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5425
  • Fax:
Mailing address:
  • Phone: 773-727-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.000755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: