Provider Demographics
NPI:1669753372
Name:MUHAMMAD, HANEEFAH (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:HANEEFAH
Middle Name:
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 ARQUILLA DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1654
Mailing Address - Country:US
Mailing Address - Phone:708-259-8776
Mailing Address - Fax:
Practice Address - Street 1:14601 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2641
Practice Address - Country:US
Practice Address - Phone:708-349-8300
Practice Address - Fax:708-349-4093
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002537224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant