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General NPI Number Information
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NPI Number | 1770285959
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Entity Type | Individual
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Provider Name | MIKAYLA CRISTINE MIX OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 2630 W BRADLEY PL
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City | CHICAGO
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State | IL
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Zip | 60618-4704
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Country | US
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Telephone | 312-955-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 N OAKLEY AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60618-4879
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Country | US
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Telephone | 847-565-9254
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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 | 056015164
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License Number State | IL
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