Basic Information
| Provider Information | |||||||||
| NPI: | 1346560349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFINITY REHAB AND THERAPY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6033 N SHERIDAN RD | ||||||||
| Address2: | SUITE 22E | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606603003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733348643 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 6033 N SHERIDAN RD | ||||||||
| Address2: | SUITE 22E | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606603003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733348643 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | CRAIG | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 7733348643 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056007751 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0001600736 | 01 | IL | BC/BS | OTHER |