Healthcare Provider Details

I. General information

NPI: 1437114972
Provider Name (Legal Business Name): ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLYMPUS DR
TINLEY PARK IL
60477-4827
US

IV. Provider business mailing address

2 OLYMPUS DR
TINLEY PARK IL
60477-4827
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-1782
  • Fax: 708-429-5868
Mailing address:
  • Phone: 708-614-1782
  • Fax: 708-429-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: