Provider Demographics
NPI:1912289422
Name:SANFORD, TONIA (OT)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 W 32ND PL
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6376
Mailing Address - Country:US
Mailing Address - Phone:309-750-9599
Mailing Address - Fax:
Practice Address - Street 1:1324 W 32ND PL
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6376
Practice Address - Country:US
Practice Address - Phone:309-750-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist