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General NPI Number Information
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NPI Number | 1558411470
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Entity Type | Individual
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Provider Name | STEPHANIE L DAVIES OTRL
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1962 N BISSELL ST 2 ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60614-5015
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Country | US
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Telephone | 773-477-7599
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Fax | 773-477-7601
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Provider Business Mailing Address
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Address Line | 1100 W MONTROSE AVE #504
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City | CHICAGO
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State | IL
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Zip | 60613-5520
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Country | US
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Telephone | 773-477-7599
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Fax | 773-477-7601
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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 | 056-003210
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License Number State | IL
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