Basic Information
| Provider Information | |||||||||
| NPI: | 1891226460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | DIRK | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15300 WEST AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083493388 | ||||||||
| FaxNumber: | 7083493334 | ||||||||
| Practice Location | |||||||||
| Address1: | 11947 S HARLEM AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083617929 | ||||||||
| FaxNumber: | 7083616310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.011899 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.