Healthcare Provider Details

I. General information

NPI: 1053486589
Provider Name (Legal Business Name): DORA NAVARRO PETERS MS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 GROSS POINT RD SUITE 308
SKOKIE IL
60077-1859
US

IV. Provider business mailing address

7300 W LUNT AVE
CHICAGO IL
60631-1153
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-2630
  • Fax: 847-674-4042
Mailing address:
  • Phone: 773-467-9901
  • Fax: 773-467-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: