Provider Demographics
NPI:1679337570
Name:KHATIB, AYA (OTR/L)
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:KHATIB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AYA
Other - Middle Name:
Other - Last Name:RAMADAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10516 RIDGE COVE DR APT 27C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1391
Mailing Address - Country:US
Mailing Address - Phone:708-340-4159
Mailing Address - Fax:
Practice Address - Street 1:11049 S FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1813
Practice Address - Country:US
Practice Address - Phone:708-528-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist