Provider Demographics
NPI:1376716720
Name:SISON, ALEX AURELIO (OT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:AURELIO
Last Name:SISON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3710
Mailing Address - Country:US
Mailing Address - Phone:847-759-8280
Mailing Address - Fax:847-759-8270
Practice Address - Street 1:950 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3710
Practice Address - Country:US
Practice Address - Phone:847-759-8280
Practice Address - Fax:847-759-8270
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist