Healthcare Provider Details

I. General information

NPI: 1437235041
Provider Name (Legal Business Name): DANA DEANNE FORTADO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 LAKE ST G
RIVER FOREST IL
60305-2247
US

IV. Provider business mailing address

7350 LAKE ST G
RIVER FOREST IL
60305-2247
US

V. Phone/Fax

Practice location:
  • Phone: 708-828-0221
  • Fax: 708-216-6534
Mailing address:
  • Phone: 708-828-0221
  • Fax: 708-216-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: