1760694889 NPI number — MRS. ELLYN FAY KEARNEY BACH OF SCIENCE OT

Table of content: MRS. ELLYN FAY KEARNEY BACH OF SCIENCE OT (NPI 1760694889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760694889 NPI number — MRS. ELLYN FAY KEARNEY BACH OF SCIENCE OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARNEY
Provider First Name:
ELLYN
Provider Middle Name:
FAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BACH OF SCIENCE OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760694889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1308 WAUKEGAN RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60025-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-486-4140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-3070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-486-4140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

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: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com