Provider Demographics
NPI:1659828259
Name:MOHANAN, NITA (OTR/L)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:MOHANAN
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 1:1967 CLARENDON LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4861
Mailing Address - Country:US
Mailing Address - Phone:847-997-9965
Mailing Address - Fax:
Practice Address - Street 1:3965 75TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7925
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056011316OtherLICENSE