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NPI Code Detail

MEDICARE: BRENDA KOVERMAN

MEDICARE: BRENDA KOVERMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist56001889IL

General Provider Information

NPI Number : 1861512477
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA KOVERMAN
Provider Business Mailing Address
First Line : 2700 N HAMPDEN CT
Second Line : #18C
City : CHICAGO
State : IL
Zip : 60614-1869
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W CONGRESS PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-5344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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