Provider Demographics
NPI:1215109558
Name:WASHINGTON, SIR GEORGE D (OT)
Entity type:Individual
Prefix:
First Name:SIR GEORGE
Middle Name:D
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 CUMBERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1120
Mailing Address - Country:US
Mailing Address - Phone:708-359-2670
Mailing Address - Fax:708-274-1979
Practice Address - Street 1:3309 CUMBERLAND TRL
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1120
Practice Address - Country:US
Practice Address - Phone:708-359-2670
Practice Address - Fax:708-274-1979
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist