Provider Demographics
NPI:1447314893
Name:REHABILITATIVE INSTITUTE OF CHICAGO
Entity type:Organization
Organization Name:REHABILITATIVE INSTITUTE OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMIDA-VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:312-493-1493
Mailing Address - Street 1:1020 N MOZART ST
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1575
Mailing Address - Country:US
Mailing Address - Phone:312-493-1493
Mailing Address - Fax:
Practice Address - Street 1:1020 N MOZART ST
Practice Address - Street 2:1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1575
Practice Address - Country:US
Practice Address - Phone:312-493-1493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty