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General NPI Number Information
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NPI Number | 1902768641
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Entity Type | Individual
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Provider Name | ISALYS ROSE FERNANDEZ OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 11950 S HARLEM AVE STE 201-8
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1998
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Country | US
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Telephone | 708-926-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 W COULTER ST APT 2R
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City | CHICAGO
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State | IL
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Zip | 60608-4125
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Country | US
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Telephone | 312-505-2738
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056015261
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License Number State | IL
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