Individual
PAUL S MIKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
360 W BUTTERFIELD RD, #230, ELMHURST, IL 60126
(630) 833-1800
(630) 833-1833
Mailing address
172 SCHILLER, ELMHURST, IL 60126-2885
(630) 758-9934
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
056003882
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056003882
STATE LICENSE
IL
01
—
977378
OT REGISTRATION NUMBER
IL
Enumeration date
05/22/2007
Last updated
11/10/2011
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