Provider Demographics
NPI:1013687748
Name:JOSEPH, ANCY (OT)
Entity Type:Individual
Prefix:
First Name:ANCY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 FOSTER ST APT 408
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1359
Mailing Address - Country:US
Mailing Address - Phone:972-921-8815
Mailing Address - Fax:
Practice Address - Street 1:1001 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2054
Practice Address - Country:US
Practice Address - Phone:847-692-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056.007954Medicaid