Provider Demographics
NPI:1275680902
Name:PUDERBAUGH, JANET (MS OTR L)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:PUDERBAUGH
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1785
Mailing Address - Country:US
Mailing Address - Phone:630-673-4987
Mailing Address - Fax:
Practice Address - Street 1:6224 PLYMOUTH CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1785
Practice Address - Country:US
Practice Address - Phone:630-792-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000284225X00000X
IL056.0002842081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist