Provider Demographics
NPI:1659314029
Name:HALLMAN, LAURA ANN (MA OTRL)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:SMID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OTRL
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:939 W MADISON ST
Practice Address - Street 2:STE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:866-868-0764
Practice Address - Fax:312-492-7953
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007456225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00451772OtherRAILROAD MEDICARE
ILP00451772OtherRAILROAD MEDICARE
IL$$$$$$$$$001Medicaid
ILK19208Medicare ID - Type Unspecified
ILP00451772Medicare PIN