Provider Demographics
NPI:1730554320
Name:PHILLIPS, AUDREY ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:ANN
Last Name:PHILLIPS
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 1:23 W SUFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2466
Mailing Address - Country:US
Mailing Address - Phone:224-659-4998
Mailing Address - Fax:
Practice Address - Street 1:355 EAST ERIE STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2654
Practice Address - Country:US
Practice Address - Phone:312-238-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1869225X00000X, 225X00000X
CAOT18348225X00000X
IL056010799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist