=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366052565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL GROSS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2020
-----------------------------------------------------
Last Update Date | 12/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 S NORTHWEST HWY STE 204
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-4237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-631-4112
-----------------------------------------------------
Fax | 773-594-2113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 RAND RD STE 300
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-2359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-324-3976
-----------------------------------------------------
Fax | 847-929-1154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 056-013252
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------