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General NPI Number Information
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NPI Number | 1851508105
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Entity Type | Individual
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Provider Name | TANYA MARIE PUREVICH OTR, OT(C)
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1401 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1858
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Country | US
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Telephone | 773-522-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 814 E 38TH PLACE #1
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City | CHICAGO
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State | IL
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Zip | 60653-1999
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Country | US
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Telephone | 773-938-1128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IL
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