Provider Demographics
NPI:1699801035
Name:SISTO THIBEAU, LAURA ANN (MOT OTRL)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:SISTO THIBEAU
Suffix:
Gender:F
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:SISTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTRL
Mailing Address - Street 1:2000 E ALGONQUIN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4189
Mailing Address - Country:US
Mailing Address - Phone:847-303-5790
Mailing Address - Fax:847-303-5795
Practice Address - Street 1:1990 E ALGONQUIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4173
Practice Address - Country:US
Practice Address - Phone:847-303-5790
Practice Address - Fax:847-303-5795
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006803225X00000X
IL056-006803225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist