Provider Demographics
NPI:1366817603
Name:PRITCHYK, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:PRITCHYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 N BROADWAY ST # 250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4235
Mailing Address - Country:US
Mailing Address - Phone:312-458-9865
Mailing Address - Fax:
Practice Address - Street 1:3712 N BROADWAY ST # 250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4235
Practice Address - Country:US
Practice Address - Phone:312-458-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004190224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant