Provider Demographics
NPI:1619097680
Name:DUNN FARNAN, CARA BETH
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:BETH
Last Name:DUNN FARNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2814
Mailing Address - Country:US
Mailing Address - Phone:708-588-0975
Mailing Address - Fax:
Practice Address - Street 1:601 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2814
Practice Address - Country:US
Practice Address - Phone:708-588-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.003206225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics