Provider Demographics
NPI:1386000560
Name:DUDEK, RENATA MARIA (COTA/L, OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:MARIA
Last Name:DUDEK
Suffix:
Gender:F
Credentials:COTA/L, OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2305
Mailing Address - Country:US
Mailing Address - Phone:773-396-3505
Mailing Address - Fax:
Practice Address - Street 1:2801 S LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4547
Practice Address - Country:US
Practice Address - Phone:773-456-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004278224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant