Basic Information
| Provider Information | |||||||||
| NPI: | 1699924092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEWARE | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | SURESH | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6005 DEMPSTER ST | ||||||||
| Address2: | |||||||||
| City: | MORTON GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600532943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474701844 | ||||||||
| FaxNumber: | 8474701842 | ||||||||
| Practice Location | |||||||||
| Address1: | 6005 DEMPSTER ST | ||||||||
| Address2: | |||||||||
| City: | MORTON GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600532943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474701844 | ||||||||
| FaxNumber: | 8474701842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2008 | ||||||||
| LastUpdateDate: | 09/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056007284 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.