Provider Demographics
NPI:1255324778
Name:YAGER, PAULETTE (OTRL)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:YAGER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14620 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2642
Mailing Address - Country:US
Mailing Address - Phone:708-403-0010
Mailing Address - Fax:708-403-0017
Practice Address - Street 1:14620 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2642
Practice Address - Country:US
Practice Address - Phone:708-403-0010
Practice Address - Fax:708-403-0017
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL87046Medicare ID - Type UnspecifiedMEDICARE PROVIDER #