Individual
JAMIE LEE FAGERBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
310 S MICHIGAN AVE UNIT 1308, CHICAGO, IL 60604-4203
(847) 440-4305
Mailing address
1736 S UNION AVE, CHICAGO, IL 60616-1153
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056.009870
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336626316
THE LOOP SLL
—
Enumeration date
08/20/2019
Last updated
08/20/2019
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