Provider Demographics
NPI:1649490053
Name:FREESE, CARRIE ANNE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANNE ELIZABETH
Last Name:FREESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 WHITEWATER DR
Mailing Address - Street 2:APT 207
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4514
Mailing Address - Country:US
Mailing Address - Phone:630-863-7521
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVERSIDE PLZ
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5808
Practice Address - Country:US
Practice Address - Phone:312-416-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant