Provider Demographics
NPI:1477762813
Name:PETERHANSEN, EVAGELIA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:EVAGELIA
Middle Name:
Last Name:PETERHANSEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KATHLEEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3126
Mailing Address - Country:US
Mailing Address - Phone:847-687-7294
Mailing Address - Fax:
Practice Address - Street 1:6440 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1752
Practice Address - Country:US
Practice Address - Phone:630-968-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist