Provider Demographics
NPI:1023559176
Name:THOMURE, ANDERSON (LCSW, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:THOMURE
Suffix:
Gender:M
Credentials:LCSW, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2401
Mailing Address - Country:US
Mailing Address - Phone:773-951-4540
Mailing Address - Fax:
Practice Address - Street 1:1813 W CUYLER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2401
Practice Address - Country:US
Practice Address - Phone:773-951-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist