Active NPI
Farida K Tavawala
- Occupational Therapist
- Glen Ellyn, IL
National Provider Identifier
1962740530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.009971
- Practice address
- 470 Fawell Blvd
Apt 511
Glen Ellyn, IL 60137-6796 - Phone
- (201) 743-9677
- NPI assigned
- Jan 16, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.009971 | IL | Primary |
Addresses
Primary practice location
470 Fawell Blvd
Apt 511
Glen Ellyn, IL 60137-6796
Mailing address
470 Fawell Blvd
Apt 511
Glen Ellyn, IL 60137-6796
Phone (201) 743-9677
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.009971 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1962740530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 FAWELL BLVD",
"address_2": "APT 511",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601376796",
"telephone_number": "201-743-9677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 FAWELL BLVD",
"address_2": "APT 511",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601376796",
"telephone_number": "201-743-9677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVAWALA",
"first_name": "FARIDA",
"middle_name": "K",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-16",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.009971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.