Provider Demographics
NPI:1184741977
Name:MAGUIRE, JOLENE KAY (OTR)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:KAY
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-2705
Mailing Address - Country:US
Mailing Address - Phone:630-654-8512
Mailing Address - Fax:630-655-9924
Practice Address - Street 1:449 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-2705
Practice Address - Country:US
Practice Address - Phone:630-654-8512
Practice Address - Fax:630-655-9924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist