Healthcare Provider Details

I. General information

NPI: 1245860287
Provider Name (Legal Business Name): ANNA STOVER MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 W BLACKHAWK ST UNIT 202
CHICAGO IL
60642-2307
US

IV. Provider business mailing address

1436 W BLACKHAWK ST UNIT 202
CHICAGO IL
60642-2307
US

V. Phone/Fax

Practice location:
  • Phone: 651-964-9936
  • Fax:
Mailing address:
  • Phone: 651-964-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.013381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: