Provider Demographics
NPI:1326323338
Name:HARE, VICKI LYNNE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNNE
Last Name:HARE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14743 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2769
Mailing Address - Country:US
Mailing Address - Phone:815-254-3830
Mailing Address - Fax:
Practice Address - Street 1:1001 E CHICAGO AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5526
Practice Address - Country:US
Practice Address - Phone:630-305-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant