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General NPI Number Information
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NPI Number | 1275197279
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Entity Type | Individual
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Provider Name | ALEXANDER ROBERT FUNG OTR
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Gender | Male
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 14601 JOHN HUMPHREY DR
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City | ORLAND PARK
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State | IL
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Zip | 60462-2641
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Country | US
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Telephone | 708-349-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1772 BRANDEIS CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-6760
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Country | US
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Telephone | 630-881-8930
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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 | 056013056
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License Number State | IL
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