Provider Demographics
NPI:1336221332
Name:ILKANICH, TUNDE A (OT)
Entity Type:Individual
Prefix:
First Name:TUNDE
Middle Name:A
Last Name:ILKANICH
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 1:150 7TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2908
Mailing Address - Country:US
Mailing Address - Phone:440-285-4999
Mailing Address - Fax:440-285-4996
Practice Address - Street 1:150 7TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2908
Practice Address - Country:US
Practice Address - Phone:440-285-4999
Practice Address - Fax:440-285-4996
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT002011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHIL4176302Medicare PIN