Provider Demographics
NPI:1134886393
Name:FLISK, MICHELLE (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FLISK
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SAMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:4061 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2611
Practice Address - Country:US
Practice Address - Phone:690-967-2000
Practice Address - Fax:708-229-0090
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-013790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist