Provider Demographics
NPI:1124520614
Name:CHORICH, CAROLYN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CHORICH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 N RAVENSWOOD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5945
Mailing Address - Country:US
Mailing Address - Phone:773-697-7333
Mailing Address - Fax:
Practice Address - Street 1:3711 N RAVENSWOOD AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5945
Practice Address - Country:US
Practice Address - Phone:773-697-7333
Practice Address - Fax:855-502-8892
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012395225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics