Basic Information
| Provider Information | |||||||||
| NPI: | 1831409028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGHESE | ||||||||
| FirstName: | ROY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16001 OAK AVE | ||||||||
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| City: | OAK FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604524028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157662301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6500 W 65TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606384962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084961515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056009140 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.