Provider Demographics
NPI:1255549630
Name:BAUTISTA, DENNIS LIM (OTR)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LIM
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:LIM
Other - Last Name:BAUTISTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:5342 W PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3346
Mailing Address - Country:US
Mailing Address - Phone:219-448-2482
Mailing Address - Fax:
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008257225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist