Healthcare Provider Details

I. General information

NPI: 1801421839
Provider Name (Legal Business Name): ALEXANDRA KATHERINE WURZ MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

750 PASQUINELLI DR STE 204
WESTMONT IL
60559-1291
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2633
  • Fax:
Mailing address:
  • Phone: 630-560-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056013497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: