Provider Demographics
NPI:1659993939
Name:BOUSHIE, ROBIN (OTR)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BOUSHIE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 LAKE COOK RD APT 227
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4472
Mailing Address - Country:US
Mailing Address - Phone:847-702-2133
Mailing Address - Fax:
Practice Address - Street 1:1695 LAKE COOK RD APT 227
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4472
Practice Address - Country:US
Practice Address - Phone:847-702-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05600972225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics