Provider Demographics
NPI:1285220848
Name:SISKA, MALLORY (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:SISKA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 S 95TH AVE STE 453
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2266
Mailing Address - Country:US
Mailing Address - Phone:708-787-0952
Mailing Address - Fax:
Practice Address - Street 1:14225 S 95TH AVE STE 453
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2266
Practice Address - Country:US
Practice Address - Phone:708-787-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013850225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist