Provider Demographics
NPI:1508009762
Name:HAND THERAPY OF LASALLE COUNTY, INC.
Entity Type:Organization
Organization Name:HAND THERAPY OF LASALLE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:NASO
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L, CHT
Authorized Official - Phone:630-886-8364
Mailing Address - Street 1:511 S OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60518-8005
Mailing Address - Country:US
Mailing Address - Phone:630-886-8364
Mailing Address - Fax:630-862-3083
Practice Address - Street 1:511 S OTTAWA ST
Practice Address - Street 2:
Practice Address - City:EARLVILLE
Practice Address - State:IL
Practice Address - Zip Code:60518-8005
Practice Address - Country:US
Practice Address - Phone:630-886-8364
Practice Address - Fax:630-862-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005093225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty