Provider Demographics
NPI:1124324470
Name:SAELE, GENESIS (DT)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:SAELE
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12036 S KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2306
Mailing Address - Country:US
Mailing Address - Phone:708-926-2523
Mailing Address - Fax:
Practice Address - Street 1:12036 S KILDARE AVE
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-2306
Practice Address - Country:US
Practice Address - Phone:708-926-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist