Provider Demographics
NPI:1609944776
Name:DELOUGHERY, MAEVE ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MAEVE
Middle Name:ANN
Last Name:DELOUGHERY
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 1:905 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0345
Mailing Address - Country:US
Mailing Address - Phone:630-904-2536
Mailing Address - Fax:
Practice Address - Street 1:905 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0345
Practice Address - Country:US
Practice Address - Phone:630-904-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist