Provider Demographics
NPI:1295852184
Name:BOGGAVARAPU, VENKATESWARA RAO (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:VENKATESWARA RAO
Middle Name:
Last Name:BOGGAVARAPU
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 SANCTUARY LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1921
Mailing Address - Country:US
Mailing Address - Phone:630-470-8758
Mailing Address - Fax:630-718-9893
Practice Address - Street 1:1024 SANCTUARY LANE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1921
Practice Address - Country:US
Practice Address - Phone:630-470-8758
Practice Address - Fax:630-718-9893
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist