Basic Information
| Provider Information | |||||||||
| NPI: | 1497170906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 WOLF RD | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE HIGHLANDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605253300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082464806 | ||||||||
| FaxNumber: | 7082464806 | ||||||||
| Practice Location | |||||||||
| Address1: | 3703 W LAKE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479981188 | ||||||||
| FaxNumber: | 8479981188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2014 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056010050 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.