Provider Demographics
NPI:1215336680
Name:VASICH, CAROL R (OTR/L, ATP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:VASICH
Suffix:
Gender:F
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1347
Mailing Address - Country:US
Mailing Address - Phone:630-420-7850
Mailing Address - Fax:
Practice Address - Street 1:3965 75TH ST STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7926
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.000720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist