Provider Demographics
NPI:1548395767
Name:O'CONNOR, MARIBETH THERESE (OTR L)
Entity type:Individual
Prefix:MS
First Name:MARIBETH
Middle Name:THERESE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15924 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1403
Mailing Address - Country:US
Mailing Address - Phone:708-444-7467
Mailing Address - Fax:708-429-5077
Practice Address - Street 1:15924 OZARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1403
Practice Address - Country:US
Practice Address - Phone:708-444-7467
Practice Address - Fax:708-429-5077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635770OtherBLUE CROSS BLUE SHIELD