Provider Demographics
NPI:1144041377
Name:SANTOS, AUTUMN KIMBERLY (OTD, OTR)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:KIMBERLY
Last Name:SANTOS
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 W ROUNDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-8610
Mailing Address - Country:US
Mailing Address - Phone:224-305-1104
Mailing Address - Fax:
Practice Address - Street 1:901 FLORSHEIM DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5200
Practice Address - Country:US
Practice Address - Phone:847-816-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist