Provider Demographics
NPI:1093062721
Name:GIRALDO, CHARLENE J (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:J
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:J
Other - Last Name:KACZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:4080 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641
Practice Address - Country:US
Practice Address - Phone:773-545-1153
Practice Address - Fax:773-545-1568
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist