Provider Demographics
NPI:1538448956
Name:MARTIN, ALICE HALL (MA/OTR)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:HALL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA/OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5908
Mailing Address - Country:US
Mailing Address - Phone:773-719-7017
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:6033 N SHERIDAN RD
Practice Address - Street 2:N6
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3003
Practice Address - Country:US
Practice Address - Phone:773-275-4800
Practice Address - Fax:773-751-2250
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist