Provider Demographics
NPI:1083731236
Name:RIDDER, PAIGE L (OTR)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:L
Last Name:RIDDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W ALTGELD ST
Mailing Address - Street 2:#2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2250
Mailing Address - Country:US
Mailing Address - Phone:773-871-0041
Mailing Address - Fax:
Practice Address - Street 1:1042 W ALTGELD ST
Practice Address - Street 2:#2F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2250
Practice Address - Country:US
Practice Address - Phone:773-871-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist