Provider Demographics
NPI:1154053361
Name:BUENO, OLIVIA (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BUENO
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 IL ROUTE 22 SUITE 1
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021
Mailing Address - Country:US
Mailing Address - Phone:847-462-8707
Mailing Address - Fax:
Practice Address - Street 1:1009 IL ROUTE 22 SUITE 1
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1339
Practice Address - Country:US
Practice Address - Phone:847-462-8707
Practice Address - Fax:847-462-9208
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist