Provider Demographics
NPI:1649803982
Name:BASKEN, LAURIE IRENE (OT)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:IRENE
Last Name:BASKEN
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 1:2171 W EXECUTIVE DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5626
Mailing Address - Country:US
Mailing Address - Phone:630-766-0505
Mailing Address - Fax:630-766-6465
Practice Address - Street 1:2171 W EXECUTIVE DR STE 500
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5626
Practice Address - Country:US
Practice Address - Phone:630-766-0505
Practice Address - Fax:630-766-6465
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist