Provider Demographics
NPI:1710142674
Name:KHORANA, CHITRA (OT)
Entity type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:KHORANA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHITRA
Other - Middle Name:
Other - Last Name:PRABHU-AJGAONKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W GENEVA RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-9141
Practice Address - Country:US
Practice Address - Phone:630-784-3251
Practice Address - Fax:630-665-8188
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
IL056003914225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$-001Medicaid
ILR03126Medicare PIN