Provider Demographics
NPI:1497819080
Name:URBAN, AMY P (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:P
Last Name:URBAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MONICA LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3076
Mailing Address - Country:US
Mailing Address - Phone:708-359-6141
Mailing Address - Fax:815-280-0732
Practice Address - Street 1:17929 GOTTSCHALK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1709
Practice Address - Country:US
Practice Address - Phone:708-206-6155
Practice Address - Fax:708-206-6159
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist