Provider Demographics
NPI:1023274081
Name:LICATA, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LICATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 WOOD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1535
Mailing Address - Country:US
Mailing Address - Phone:630-993-0953
Mailing Address - Fax:
Practice Address - Street 1:1001 E CHICAGO AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5526
Practice Address - Country:US
Practice Address - Phone:630-305-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist