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General NPI Number Information
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NPI Number | 1144041377
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Entity Type | Individual
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Provider Name | AUTUMN KIMBERLY SANTOS OTD, OTR
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 901 FLORSHEIM DR
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5200
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Country | US
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Telephone | 847-816-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 4485 W ROUNDSTONE WAY
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City | WAUKEGAN
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State | IL
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Zip | 60085-8610
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Country | US
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Telephone | 224-305-1104
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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 | 056.016288
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License Number State | IL
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