Provider Demographics
NPI:1316068661
Name:FIELDMAN, PIETERTJE (DT)
Entity type:Individual
Prefix:
First Name:PIETERTJE
Middle Name:
Last Name:FIELDMAN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8538 STEVEN PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1181
Mailing Address - Country:US
Mailing Address - Phone:708-743-5336
Mailing Address - Fax:708-614-6261
Practice Address - Street 1:9325 FOREST GLEN CT
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5281
Practice Address - Country:US
Practice Address - Phone:708-478-1820
Practice Address - Fax:708-478-3316
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist