Healthcare Provider Details

I. General information

NPI: 1467050344
Provider Name (Legal Business Name): LILY VANDERSTEEG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S MAIN ST
CROWN POINT IN
46307-0114
US

IV. Provider business mailing address

3131 WHISPER DR
SCHERERVILLE IN
46375-3103
US

V. Phone/Fax

Practice location:
  • Phone: 219-323-8700
  • Fax:
Mailing address:
  • Phone: 773-578-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31007217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: