Provider Demographics
NPI:1477958551
Name:BUSHELL, MOIRA PRIVEN (OTD, MED, OTR/L, BCP)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:PRIVEN
Last Name:BUSHELL
Suffix:
Gender:F
Credentials:OTD, MED, OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 COPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6878
Mailing Address - Country:US
Mailing Address - Phone:516-241-0430
Mailing Address - Fax:
Practice Address - Street 1:116 COPPERWOOD DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6878
Practice Address - Country:US
Practice Address - Phone:516-241-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist