Provider Demographics
NPI:1538839014
Name:STEGLICH, RYAN MICHAEL (COTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:STEGLICH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 N NARRAGANSETT AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2447
Mailing Address - Country:US
Mailing Address - Phone:773-808-4388
Mailing Address - Fax:
Practice Address - Street 1:350 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3464
Practice Address - Country:US
Practice Address - Phone:847-884-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005460224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant