1922164243 NPI number — FANG-LING LIN-MILLMAN M.S., OTRL

Table of content: FANG-LING LIN-MILLMAN M.S., OTRL (NPI 1922164243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922164243 NPI number — FANG-LING LIN-MILLMAN M.S., OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN-MILLMAN
Provider First Name:
FANG-LING
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIN
Provider Other First Name:
FANG-LING
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., OTRL
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922164243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3551 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-275-2600
Provider Business Mailing Address Fax Number:
630-275-2698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3551 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-275-2600
Provider Business Practice Location Address Fax Number:
630-275-2698
Provider Enumeration Date:
12/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  056.003427 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)