Healthcare Provider Details

I. General information

NPI: 1073044020
Provider Name (Legal Business Name): MAGGIE CORNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

10040 S 53RD AVE
OAK LAWN IL
60453-3812
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-9890
  • Fax:
Mailing address:
  • Phone: 708-668-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number056011364
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056011364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: