Provider Demographics
NPI:1770673972
Name:HICKS, JANET (OT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10324 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4643
Mailing Address - Country:US
Mailing Address - Phone:708-952-9667
Mailing Address - Fax:
Practice Address - Street 1:3105 N WILKE RD
Practice Address - Street 2:SUITE H
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1495
Practice Address - Country:US
Practice Address - Phone:847-255-8690
Practice Address - Fax:847-255-2260
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist