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General NPI Number Information
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NPI Number | 1669690038
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Entity Type | Organization
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Legal Business Name | CHICAGO LIGHTHOUSE
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1850 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60608-1228
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Country | US
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Telephone | 312-666-1331
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Fax | 312-506-0103
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Provider Business Mailing Address
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Address Line | 1850 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60608-1228
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Country | US
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Telephone | 312-666-1331
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Fax | 312-506-0103
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Authorized Official
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Title or Position | DIRECTOR OF CHILCREN SERVICES
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Name | MRS. MARY ZABELSKI
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Credential |
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Telephone | 312-666-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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