Provider Demographics
NPI:1942639828
Name:TISCHHAUSER, MICHELLE LEANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEANN
Last Name:TISCHHAUSER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3703 W LAKE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1223
Mailing Address - Country:US
Mailing Address - Phone:847-998-1188
Mailing Address - Fax:
Practice Address - Street 1:3703 W LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1223
Practice Address - Country:US
Practice Address - Phone:847-998-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001793224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant