Basic Information
| Provider Information | |||||||||
| NPI: | 1033556956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS, MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21393 BRAMBLE DR | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604239463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159221804 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21393 BRAMBLE DR | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604239463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159221804 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2013 | ||||||||
| LastUpdateDate: | 06/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 056009727 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.