Provider Demographics
NPI:1508052804
Name:SHEEHAN, MICHELE C (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:SHEEHAN
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 1:18924 PARKWAY LN
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9101
Mailing Address - Country:US
Mailing Address - Phone:708-478-8876
Mailing Address - Fax:
Practice Address - Street 1:19100 CRESCENT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7501
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics