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General NPI Number Information
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NPI Number | 1093272346
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Entity Type | Individual
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Provider Name | OLESYA ANNA KLOCEK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 3691 WILLOWCREEK RD STE 100
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City | PORTAGE
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State | IN
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Zip | 46368-5000
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Country | US
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Telephone | 219-921-1444
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Fax | 219-926-6926
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Provider Business Mailing Address
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Address Line | 5872 E ANDOVER DR
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City | HANOVER PARK
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State | IL
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Zip | 60133-5239
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Country | US
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Telephone | 630-398-7771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056012789
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License Number State | IL
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