Provider Demographics
NPI:1861269375
Name:TROTSKY, PAULETTE J (MED LBS1)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:J
Last Name:TROTSKY
Suffix:
Gender:F
Credentials:MED LBS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 PATHFINDER CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8725
Mailing Address - Country:US
Mailing Address - Phone:815-955-2022
Mailing Address - Fax:
Practice Address - Street 1:2541 DIVISION ST STE 106
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8737
Practice Address - Country:US
Practice Address - Phone:815-396-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist