Provider Demographics
NPI:1932429859
Name:MISHECK, ROSEANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:
Last Name:MISHECK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 CRESCENT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7526
Mailing Address - Country:US
Mailing Address - Phone:708-478-5400
Mailing Address - Fax:708-478-5300
Practice Address - Street 1:19100 CRESCENT DR STE 101
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7526
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:708-478-5300
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002221225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics