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General NPI Number Information
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NPI Number | 1679875165
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Entity Type | Individual
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Provider Name | HAILEY CHASSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 3421 NORTH SEMINARY AVENUE SUITE 1N
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 312-480-1720
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Fax |
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Provider Business Mailing Address
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Address Line | 3421 N SEMINARY AVE APT 1N UNIT C
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City | CHICAGO
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State | IL
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Zip | 60657-9036
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Country | US
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Telephone | 773-687-9146
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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 | 056009151
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License Number State | IL
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