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General NPI Number Information
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NPI Number | 1558706861
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Entity Type | Individual
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Provider Name | MALGORZATA HELENA MALESA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 920 N SEMINARY AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-2996
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Country | US
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Telephone | 815-338-1749
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Fax |
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Provider Business Mailing Address
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Address Line | 20655 ELA RD
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City | DEER PARK
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State | IL
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Zip | 60010-3509
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Country | US
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Telephone | 847-606-8011
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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 | 056-005986
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License Number State | IL
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