Provider Demographics
NPI:1164576690
Name:PUTMAN, ANITA MICHELLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MICHELLE
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:MICHELLE
Other - Last Name:PUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:2820 W ARMITAGE AVE STE 4
Practice Address - Street 2:ACCELERATED REHABILITATION CENTERS LTD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6318
Practice Address - Country:US
Practice Address - Phone:773-394-0796
Practice Address - Fax:773-394-3342
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001471174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL600040OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP
IL599990OtherMEDICARE GROUP NUMBER
IL600040OtherMEDICARE GROUP NUMBER
ILK49857Medicare PIN