Provider Demographics
NPI:1427474493
Name:KLUS-SALISBURY, JAMES ROLAND (OT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROLAND
Last Name:KLUS-SALISBURY
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 1:1965 THORNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3632
Mailing Address - Country:US
Mailing Address - Phone:847-894-3300
Mailing Address - Fax:414-299-5253
Practice Address - Street 1:1965 THORNWOOD LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3632
Practice Address - Country:US
Practice Address - Phone:847-894-3300
Practice Address - Fax:414-299-5253
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist