Provider Demographics
NPI:1588089023
Name:WORSWICK, JEANNA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:WORSWICK
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38071 N ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9731
Mailing Address - Country:US
Mailing Address - Phone:847-651-9270
Mailing Address - Fax:
Practice Address - Street 1:884 W NIPPERSINK RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-3701
Practice Address - Country:US
Practice Address - Phone:847-270-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist