Provider Demographics
NPI:1639854961
Name:LATZ, CHLOE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:LATZ
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 1:39250 N WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9236
Mailing Address - Country:US
Mailing Address - Phone:847-204-2892
Mailing Address - Fax:
Practice Address - Street 1:3300 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7126
Practice Address - Country:US
Practice Address - Phone:847-795-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist