Provider Demographics
NPI:1487829529
Name:LAVIGNE, MIGNON JUANITA (OT)
Entity Type:Individual
Prefix:MRS
First Name:MIGNON
Middle Name:JUANITA
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8559 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5622
Mailing Address - Country:US
Mailing Address - Phone:773-488-5369
Mailing Address - Fax:
Practice Address - Street 1:8559 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5622
Practice Address - Country:US
Practice Address - Phone:773-488-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist