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General NPI Number Information
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NPI Number | 1679607253
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Entity Type | Individual
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Provider Name | TIA NGO OT
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 55 S GREELEY ST
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City | PALATINE
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State | IL
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Zip | 60067-6174
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Country | US
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Telephone | 847-963-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 477 E RAILROAD AVE
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City | BARTLETT
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State | IL
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Zip | 60103-4304
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Country | US
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Telephone |
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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 | 056007392
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License Number State | IL
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