Provider Demographics
NPI:1215391487
Name:SMALL, ALISON KYLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:KYLE
Last Name:SMALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:KYLE
Other - Last Name:GARLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-890-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-1323
Practice Address - Fax:708-684-4914
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist