Provider Demographics
NPI:1407021538
Name:TIAN, MANDY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 N WELLS ST
Mailing Address - Street 2:UNIT 1206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1970
Mailing Address - Country:US
Mailing Address - Phone:832-526-5483
Mailing Address - Fax:
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:BOX 142
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-327-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008321225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics