Provider Demographics
NPI:1487017661
Name:IRMEN, STEFANIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:IRMEN
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 1:5815 N SHERIDAN RD APT 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3822
Mailing Address - Country:US
Mailing Address - Phone:847-917-1465
Mailing Address - Fax:
Practice Address - Street 1:5815 N SHERIDAN RD APT 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3822
Practice Address - Country:US
Practice Address - Phone:847-917-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist