Provider Demographics
NPI:1700915642
Name:MARGOLIES, EVELYN
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:MARGOLIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 W CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1123
Mailing Address - Country:US
Mailing Address - Phone:773-973-4460
Mailing Address - Fax:
Practice Address - Street 1:4232 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2008
Practice Address - Country:US
Practice Address - Phone:847-674-0839
Practice Address - Fax:847-869-7380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILEI#EM27650798POtherPROVIDER CONNECTION EI NU