Provider Demographics
NPI:1215289814
Name:SEROCKE, CHRISTINA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SEROCKE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:SEROCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:4200 MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-1872
Mailing Address - Country:US
Mailing Address - Phone:847-801-5175
Mailing Address - Fax:847-801-5176
Practice Address - Street 1:4200 MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-1872
Practice Address - Country:US
Practice Address - Phone:847-801-5175
Practice Address - Fax:847-801-5176
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist