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General NPI Number Information
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NPI Number | 1457646556
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Entity Type | Individual
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Provider Name | TONY CHACKO KOCHUPARAMBIL OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 3957 GREENWOOD ST
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City | SKOKIE
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State | IL
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Zip | 60076-1940
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Country | US
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Telephone | 847-294-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 GREENWOOD ST
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City | SKOKIE
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State | IL
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Zip | 60076-1940
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Country | US
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Telephone | 847-294-2355
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 056006578
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.006578
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License Number State | IL
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