Individual provider Active NPI

Rose Pittelli

  • Occupational Therapy Assistant
  • Chicago Ridge, IL
National Provider Identifier
1366860017
Registry record updated Mar 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
057.000622 Issued in IL
Practice address
10300 Southwest Hwy
Chicago Ridge, IL 60415-1426
Phone
(708) 425-1100
Fax
(708) 425-0209
NPI assigned
Mar 31, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 057.000622 IL Primary

Addresses

Primary practice location

10300 Southwest Hwy
Chicago Ridge, IL 60415-1426

Mailing address

11334 S Champlain Ave
Chicago, IL 60628-5122
Phone (773) 680-8745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
057.000622ILMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1366860017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11334 S CHAMPLAIN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606285122",
            "telephone_number": "773-680-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 SOUTHWEST HWY",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604151426",
            "telephone_number": "708-425-1100",
            "fax_number": "708-425-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTELLI",
        "first_name": "ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-31",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.000622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.