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General NPI Number Information
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NPI Number | 1891208559
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Entity Type | Individual
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Provider Name | IONUT L BRADESCU
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Gender | Male
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 10 N SUMMIT AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-3310
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Country | US
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Telephone | 847-696-7356
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Fax |
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Provider Business Mailing Address
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Address Line | 5148 W CARMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2324
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057004813
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License Number State | IL
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