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General NPI Number Information
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NPI Number | 1790461499
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Entity Type | Individual
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Provider Name | JENNA VANGALIS OTD, OT/R
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 280 SAUNDERS RD
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City | RIVERWOODS
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State | IL
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Zip | 60015-3835
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Country | US
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Telephone | 847-948-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 815 W WELLINGTON AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60657-9713
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Country | US
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Telephone | 312-315-3639
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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 | 056.015508
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License Number State | IL
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