Provider Demographics
NPI:1093908303
Name:OCONNOR, PATRICK LANDSDALE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:LANDSDALE
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 N HUMBOLDT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5015
Mailing Address - Country:US
Mailing Address - Phone:773-216-6144
Mailing Address - Fax:773-486-5814
Practice Address - Street 1:1647 N HUMBOLDT BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5015
Practice Address - Country:US
Practice Address - Phone:773-216-6144
Practice Address - Fax:773-486-5814
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist