Provider Demographics
NPI:1417294513
Name:DOVER, LAVINIA ARCHRANELL (MED)
Entity Type:Individual
Prefix:MRS
First Name:LAVINIA
Middle Name:ARCHRANELL
Last Name:DOVER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-2150
Mailing Address - Country:US
Mailing Address - Phone:773-507-0261
Mailing Address - Fax:
Practice Address - Street 1:650 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2150
Practice Address - Country:US
Practice Address - Phone:773-507-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist