Provider Demographics
NPI:1720152630
Name:TARNOW, LILLIAN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIE
Last Name:TARNOW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 N SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4226
Mailing Address - Country:US
Mailing Address - Phone:773-267-4142
Mailing Address - Fax:
Practice Address - Street 1:4711 GOLF RD STE 403
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1242
Practice Address - Country:US
Practice Address - Phone:847-674-2630
Practice Address - Fax:847-674-4042
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-003759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist