Provider Demographics
NPI:1821445404
Name:ITTY, MAREEN (MOT)
Entity Type:Individual
Prefix:
First Name:MAREEN
Middle Name:
Last Name:ITTY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MAREEN
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:350 S GREENLEAF ST
Practice Address - Street 2:SUITE 403
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5709
Practice Address - Country:US
Practice Address - Phone:847-596-7640
Practice Address - Fax:847-596-7641
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011389225X00000X
AZOTH-007857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist