Provider Demographics
NPI:1407036742
Name:BLAZEVIC, ANNA MARIA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:BLAZEVIC
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:BLAZEVIC
Other - Last Name:CARGILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:9011 W CERMAK RD
Mailing Address - Street 2:FIRST FLOOR FRONT
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1029
Mailing Address - Country:US
Mailing Address - Phone:773-339-1390
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-261-1210
Practice Address - Fax:630-261-1211
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist