Individual
FANI LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 W ROOSEVELT RD, RM 413, CHICAGO, IL 60608-1316
(312) 413-1555
Mailing address
1640 W ROOSEVELT RD RM 413, CHICAGO, IL 60608-1316
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056007680
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056007680
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
04/25/2016
Last updated
06/13/2016
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