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General NPI Number Information
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NPI Number | 1730426743
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Entity Type | Individual
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Provider Name | MONIQUE HARDEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 4314 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60653-3119
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Country | US
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Telephone | 773-286-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 12536 S PAULINA
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City | CALUMET PARK
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State | IL
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Zip | 60827
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Country | US
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Telephone | 773-209-1315
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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 | 056004823
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License Number State | IL
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