Individual
MICHELLE ANN YTAC HEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16170 KINGSPORT RD, ORLAND PARK, IL 60467-5602
(708) 326-1550
(708) 326-1557
Mailing address
1000 FIANNA WAY, FORT SMITH, AR 72919-0001
(479) 201-4835
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
3880
MS
225XG0600X
Gerontology Occupational Therapist
056008720
IL
225XG0600X
Gerontology Occupational Therapist
Primary
3880
MS
225XP0019X
Physical Rehabilitation Occupational Therapist
056008720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346420015
—
AR
Enumeration date
05/01/2015
Last updated
08/13/2021
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