Provider Demographics
NPI:1386148393
Name:JOSTS, DIONYSIAN A (OTR/L)
Entity type:Individual
Prefix:
First Name:DIONYSIAN
Middle Name:A
Last Name:JOSTS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1311
Mailing Address - Country:US
Mailing Address - Phone:269-830-8590
Mailing Address - Fax:
Practice Address - Street 1:11S230 S JACKSON ST STE 103
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7099
Practice Address - Country:US
Practice Address - Phone:773-739-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2023-03-09
Deactivation Date:2023-02-22
Deactivation Code:
Reactivation Date:2023-03-07
Provider Licenses
StateLicense IDTaxonomies
IL056.015316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist