Provider Demographics
NPI:1790233096
Name:NOVA OCCUPATIONAL THERAPY P.C
Entity Type:Organization
Organization Name:NOVA OCCUPATIONAL THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAMAREE
Authorized Official - Middle Name:CHARISSE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:312-912-2624
Mailing Address - Street 1:3000 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4458
Mailing Address - Country:US
Mailing Address - Phone:773-475-7651
Mailing Address - Fax:773-475-7564
Practice Address - Street 1:3000 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4458
Practice Address - Country:US
Practice Address - Phone:312-912-2624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009507261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation