Provider Demographics
NPI:1710004627
Name:SIKANDER, MANSOOR KAMAL (OTR)
Entity Type:Individual
Prefix:MR
First Name:MANSOOR
Middle Name:KAMAL
Last Name:SIKANDER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 DENISON RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6758
Mailing Address - Country:US
Mailing Address - Phone:630-207-1176
Mailing Address - Fax:
Practice Address - Street 1:10124 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3738
Practice Address - Country:US
Practice Address - Phone:708-907-7113
Practice Address - Fax:708-907-7005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003627225200000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant