Provider Demographics
NPI:1366594004
Name:YASUKAWA, AUDREY (OT)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:YASUKAWA
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 1:1426 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2116
Mailing Address - Country:US
Mailing Address - Phone:773-271-7832
Mailing Address - Fax:
Practice Address - Street 1:E. 65TH ST
Practice Address - Street 2:AT LAKE MICHIGAN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1395
Practice Address - Country:US
Practice Address - Phone:773-256-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics