Provider Demographics
NPI:1881065084
Name:TRI-NUE THERAPY P.C.
Entity type:Organization
Organization Name:TRI-NUE THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYB
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:708-755-4636
Mailing Address - Street 1:825 W FITZHENRY CT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1114
Mailing Address - Country:US
Mailing Address - Phone:708-755-4636
Mailing Address - Fax:708-755-4690
Practice Address - Street 1:825 W FITZHENRY CT
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1114
Practice Address - Country:US
Practice Address - Phone:708-755-4636
Practice Address - Fax:708-755-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002741225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL023Medicaid