Provider Demographics
NPI:1922397595
Name:VANA, RICHARD PAUL (COTA/L)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:VANA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18318 EXCHANGE AVE
Mailing Address - Street 2:1B
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2964
Mailing Address - Country:US
Mailing Address - Phone:708-895-8173
Mailing Address - Fax:
Practice Address - Street 1:18318 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2964
Practice Address - Country:US
Practice Address - Phone:708-895-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001156224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant