Provider Demographics
NPI:1689169310
Name:HIRSH, SHARI BROKOWSKY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:BROKOWSKY
Last Name:HIRSH
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 1:333 W HUBBARD ST APT 322
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4977
Mailing Address - Country:US
Mailing Address - Phone:925-895-2665
Mailing Address - Fax:
Practice Address - Street 1:333 W HUBBARD ST APT 322
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4977
Practice Address - Country:US
Practice Address - Phone:925-895-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012547225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty