Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan R Roberts

Individual provider Occupational Therapist · NPI 1336879055

Ethan R Roberts is an Occupational Therapist in Private Practice in Chicago, Illinois. Qualified in 2022, 4 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
4
Licensed in
IL
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

1915 S Archer Ave
Chicago, IL 60616-1618
Phone: (312) 674-9132
Fax: (312) 674-9392
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 056014948 (IL)
Occupational Therapist Taxonomy 225X00000X

Record details

NPI number1336879055
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 15, 2022
Last updated in NPPESJuly 18, 2022
Certification dateJuly 18, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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