Provider Demographics
NPI:1467641530
Name:OLEARY, EILEEN L (LMT, BS NUTRITION)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:L
Last Name:OLEARY
Suffix:
Gender:F
Credentials:LMT, BS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5438
Mailing Address - Country:US
Mailing Address - Phone:708-755-1111
Mailing Address - Fax:708-755-0665
Practice Address - Street 1:3033 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-5438
Practice Address - Country:US
Practice Address - Phone:708-755-1111
Practice Address - Fax:708-755-0665
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist