Provider Demographics
NPI:1700116225
Name:JOSEPH, ROBERT DAVID
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:DAVID
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:206 W MAPLE AVE
Mailing Address - Street 2:2C
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2174
Mailing Address - Country:US
Mailing Address - Phone:773-793-6950
Mailing Address - Fax:847-764-7721
Practice Address - Street 1:206 W MAPLE AVE
Practice Address - Street 2:2C
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2174
Practice Address - Country:US
Practice Address - Phone:773-793-6950
Practice Address - Fax:847-764-7721
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005664225X00000X, 225XE1200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation