Provider Demographics
NPI:1699028910
Name:EBERT, PATTI-ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PATTI-ANN
Middle Name:
Last Name:EBERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:PATTI-ANN
Other - Middle Name:
Other - Last Name:RYGULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:850 BROOK FOREST AVE
Mailing Address - Street 2:UNIT M
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-730-1800
Mailing Address - Fax:815-730-1835
Practice Address - Street 1:850 BROOK FOREST AVE.
Practice Address - Street 2:UNIT L
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-260-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009357225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist