Provider Demographics
NPI:1447980172
Name:DIZON CALIMUTAN, STEPHANIE RACHEL (OT)
Entity type:Individual
Prefix:
First Name:STEPHANIE RACHEL
Middle Name:
Last Name:DIZON CALIMUTAN
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 W IRVING PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2808
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:630-933-1550
Practice Address - Street 1:4445 W IRVING PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2808
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:630-933-1550
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0019X
IL056013759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation