Basic Information
Provider Information
NPI: 1376697276
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRIFFIN
FirstName: JOSEPH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT-SC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 929 W HIGGINS RD
Address2:  
City: SCHAUMBURG
State: IL
PostalCode: 601953203
CountryCode: US
TelephoneNumber: 8472854200
FaxNumber: 8478850130
Practice Location
Address1: 929 W HIGGINS RD
Address2:  
City: SCHAUMBURG
State: IL
PostalCode: 601953203
CountryCode: US
TelephoneNumber: 8472854200
FaxNumber: 8478850130
Other Information
ProviderEnumerationDate: 01/22/2007
LastUpdateDate: 07/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246Z00000X  Y Technologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other 

No ID Information.


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