Provider Demographics
NPI:1043581853
Name:PRZYBYLAK, ROBERT JOHN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:PRZYBYLAK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2826
Mailing Address - Country:US
Mailing Address - Phone:814-392-4531
Mailing Address - Fax:
Practice Address - Street 1:1520 KENSINGTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2139
Practice Address - Country:US
Practice Address - Phone:630-413-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002574L225X00000X
NY012673-1225X00000X
CT002927225X00000X
OH004146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist