Provider Demographics
NPI:1437235041
Name:FORTADO, DANA DEANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:DEANNE
Last Name:FORTADO
Suffix:
Gender:F
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 1:7350 LAKE ST
Mailing Address - Street 2:G
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2247
Mailing Address - Country:US
Mailing Address - Phone:708-828-0221
Mailing Address - Fax:708-216-6534
Practice Address - Street 1:7350 LAKE ST
Practice Address - Street 2:G
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2247
Practice Address - Country:US
Practice Address - Phone:708-828-0221
Practice Address - Fax:708-216-6534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635382OtherBLUE CROSS BLUE SHIELD