Individual provider Active NPI

Elizabeth Wanka, OTR/L

  • Pediatric Occupational Therapist
  • Downers Grove, IL
National Provider Identifier
1912165994
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
056.008311 Issued in IL
Practice address
5201 Walnut Ave Ste 4
Downers Grove, IL 60515-4073
Phone
(630) 964-4025
Fax
(630) 964-4797
NPI assigned
May 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 056.008311 IL Primary

Addresses

Primary practice location

5201 Walnut Ave Ste 4
Downers Grove, IL 60515-4073

Mailing address

5201 Walnut Ave Ste 4
Downers Grove, IL 60515-4073
Phone (630) 964-4707

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
056.008311ILMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Rehabilitation Services Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1912165994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 WALNUT AVE STE 4",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605154073",
            "telephone_number": "630-964-4707",
            "fax_number": "630-964-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WALNUT AVE STE 4",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605154073",
            "telephone_number": "630-964-4025",
            "fax_number": "630-964-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANKA",
        "first_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056.008311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.