1144400334 NPI number — REGINA SOKALER WOLGEL OTR/L

Table of content: REGINA SOKALER WOLGEL OTR/L (NPI 1144400334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144400334 NPI number — REGINA SOKALER WOLGEL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLGEL
Provider First Name:
REGINA
Provider Middle Name:
SOKALER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLGEL
Provider Other First Name:
REGINA
Provider Other Middle Name:
ALISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144400334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3639 GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-750-5000
Provider Business Mailing Address Fax Number:
847-574-8009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3639 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-750-5000
Provider Business Practice Location Address Fax Number:
847-574-8009
Provider Enumeration Date:
11/06/2007

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: 174400000X , with the licence number:  056.003103 , 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)