Provider Demographics
NPI:1821472465
Name:BUCHENAU, ERICA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:BUCHENAU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:17413 E 3000 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:ODELL
Mailing Address - State:IL
Mailing Address - Zip Code:60460-8095
Mailing Address - Country:US
Mailing Address - Phone:815-931-1000
Mailing Address - Fax:
Practice Address - Street 1:212 BARNEY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5271
Practice Address - Country:US
Practice Address - Phone:815-931-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist