Provider Demographics
NPI: | 1841338860 |
---|---|
Name: | ROGEL, PATRICIA LOUISE (CO, LO, OTR/L) |
Entity type: | Individual |
Prefix: | |
First Name: | PATRICIA |
Middle Name: | LOUISE |
Last Name: | ROGEL |
Suffix: | |
Gender: | F |
Credentials: | CO, LO, OTR/L |
Other - Prefix: | |
Other - First Name: | PATRICIA |
Other - Middle Name: | LOUISE |
Other - Last Name: | TRESE |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | CO, OTR |
Mailing Address - Street 1: | 4711 GOLF RD STE 525 |
Mailing Address - Street 2: | |
Mailing Address - City: | SKOKIE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60076-1217 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 224-470-8550 |
Mailing Address - Fax: | 224-470-8553 |
Practice Address - Street 1: | 4711 GOLF RD |
Practice Address - Street 2: | STE 1055 |
Practice Address - City: | SKOKIE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60076-1224 |
Practice Address - Country: | US |
Practice Address - Phone: | 224-470-8550 |
Practice Address - Fax: | 224-470-8553 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-02 |
Last Update Date: | 2022-10-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 56003649 | 225X00000X |
IL | 213000146 | 222Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 222Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |