Provider Demographics
NPI:1689207144
Name:ALI, SHAIK HYDER ZISHAN (OT)
Entity type:Individual
Prefix:
First Name:SHAIK
Middle Name:HYDER ZISHAN
Last Name:ALI
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 1:1535 LAKE COOK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1452
Mailing Address - Country:US
Mailing Address - Phone:224-522-6550
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 306
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1452
Practice Address - Country:US
Practice Address - Phone:224-522-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist