Provider Demographics
NPI:1437392826
Name:KUMAR, HARSHADA AMRENDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:HARSHADA
Middle Name:AMRENDRA
Last Name:KUMAR
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 1:558 CLEAVLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-9021
Mailing Address - Country:US
Mailing Address - Phone:630-674-1187
Mailing Address - Fax:
Practice Address - Street 1:5625 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1349
Practice Address - Country:US
Practice Address - Phone:630-674-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056005280261QX0100X
IL056.005280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine