Provider Demographics
NPI:1780024539
Name:TRAFICANTI, MARY F (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:TRAFICANTI
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 1:1058 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4040
Mailing Address - Country:US
Mailing Address - Phone:630-953-8386
Mailing Address - Fax:
Practice Address - Street 1:420 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4980
Practice Address - Country:US
Practice Address - Phone:630-832-2300
Practice Address - Fax:630-516-0351
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.000947225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation