Provider Demographics
NPI:1720074354
Name:HIRSCHFELD, THEODORE M (MS, ATC, OTC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:M
Last Name:HIRSCHFELD
Suffix:
Gender:M
Credentials:MS, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5107
Mailing Address - Country:US
Mailing Address - Phone:847-830-9899
Mailing Address - Fax:847-574-7439
Practice Address - Street 1:200 AMBER CT
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5107
Practice Address - Country:US
Practice Address - Phone:847-830-9899
Practice Address - Fax:847-574-7439
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0007252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer