Provider Demographics
NPI:1497225817
Name:BRUNSO, VALERIE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BRUNSO
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 W SCHUBERT AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1266
Mailing Address - Country:US
Mailing Address - Phone:317-201-6626
Mailing Address - Fax:
Practice Address - Street 1:1422 W WILLOW ST STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8976
Practice Address - Country:US
Practice Address - Phone:030-077-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist