Provider Demographics
NPI:1205392347
Name:HULT, LILY ELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:ELISE
Last Name:HULT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N HUDSON AVE UNIT 1704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6703
Mailing Address - Country:US
Mailing Address - Phone:317-640-2523
Mailing Address - Fax:
Practice Address - Street 1:2800 W FULTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1737
Practice Address - Country:US
Practice Address - Phone:773-702-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011394225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology