Provider Demographics
NPI:1669719795
Name:MUTHAMI, STANLEY NJARAMBA (OTR)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:NJARAMBA
Last Name:MUTHAMI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N PIER DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-4016
Mailing Address - Country:US
Mailing Address - Phone:815-654-0848
Mailing Address - Fax:
Practice Address - Street 1:244 N PIER DR
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-4016
Practice Address - Country:US
Practice Address - Phone:815-654-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005299225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist