Provider Demographics
NPI:1255163978
Name:HOUSTON, NAOMI ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:ELIZABETH
Last Name:HOUSTON
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 1:921 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5838
Mailing Address - Country:US
Mailing Address - Phone:708-247-4071
Mailing Address - Fax:
Practice Address - Street 1:1144 LAKE ST STE 200B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1043
Practice Address - Country:US
Practice Address - Phone:708-763-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist