Provider Demographics
NPI:1891143145
Name:AZEEMUDDIN, ALEEA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEEA
Middle Name:
Last Name:AZEEMUDDIN
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 1:260 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3141
Mailing Address - Country:US
Mailing Address - Phone:224-795-1413
Mailing Address - Fax:
Practice Address - Street 1:260 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3141
Practice Address - Country:US
Practice Address - Phone:224-795-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist