Provider Demographics
NPI:1558795740
Name:GLANTZ, CORALIE H (OT)
Entity Type:Individual
Prefix:
First Name:CORALIE
Middle Name:H
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 INDIAN TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1627
Mailing Address - Country:US
Mailing Address - Phone:847-945-1917
Mailing Address - Fax:847-945-1966
Practice Address - Street 1:1560 INDIAN TRAIL DR
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-1627
Practice Address - Country:US
Practice Address - Phone:847-945-1917
Practice Address - Fax:847-945-1966
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist