Provider Demographics
NPI:1073635603
Name:WALLOCH, CHRISTY LYN (OTD, OTR-L)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:LYN
Last Name:WALLOCH
Suffix:
Gender:F
Credentials:OTD, OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 N MARION ST # 1
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1910
Mailing Address - Country:US
Mailing Address - Phone:708-660-8055
Mailing Address - Fax:708-660-8055
Practice Address - Street 1:600 S PAULINA ST STE 1009B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-8747
Practice Address - Fax:312-942-8747
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics