Provider Demographics
NPI:1548382450
Name:AMBROZAITIS, RITA NORA (MS OTR)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:NORA
Last Name:AMBROZAITIS
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 N GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1222
Mailing Address - Country:US
Mailing Address - Phone:773-791-8283
Mailing Address - Fax:773-404-7570
Practice Address - Street 1:4339 N GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1222
Practice Address - Country:US
Practice Address - Phone:773-791-8283
Practice Address - Fax:773-404-7570
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636401OtherBLUE CROSS BLUE SHIELD