Provider Demographics
NPI:1346400157
Name:KOVIC, MARK (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KOVIC
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:STANLEY
Other - Last Name:STOJAKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 31ST ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 31ST ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1235
Practice Address - Country:US
Practice Address - Phone:630-515-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist