Provider Demographics
NPI:1083227011
Name:TOLAND, ELIZABETH ELLEN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:TOLAND
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ELLEN
Other - Last Name:HASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10415 OCONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1776
Mailing Address - Country:US
Mailing Address - Phone:708-912-8072
Mailing Address - Fax:
Practice Address - Street 1:11411 183RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9450
Practice Address - Country:US
Practice Address - Phone:708-478-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056013742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1962680009Medicaid