Provider Demographics
NPI:1023773603
Name:PATINO, DEBBIE (OT)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:PATINO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 PORT ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9197
Mailing Address - Country:US
Mailing Address - Phone:224-650-0748
Mailing Address - Fax:
Practice Address - Street 1:263 DENNIS LN
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1319
Practice Address - Country:US
Practice Address - Phone:773-330-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014572225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics