Provider Demographics
NPI:1154745792
Name:VITA, ELEANOR FINNEY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:FINNEY
Last Name:VITA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ELEANOR
Other - Middle Name:SUSAN
Other - Last Name:FINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1319 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3233
Mailing Address - Country:US
Mailing Address - Phone:847-853-8283
Mailing Address - Fax:
Practice Address - Street 1:3703 W. LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-998-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-001001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist