Provider Demographics
NPI:1710578224
Name:NASREDDINE, ALI (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:NASREDDINE
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1914
Mailing Address - Fax:
Practice Address - Street 1:1093 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1429
Practice Address - Country:US
Practice Address - Phone:248-690-5577
Practice Address - Fax:248-308-1979
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21469225X00000X
MI5201013335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist