Provider Demographics
NPI:1760824296
Name:BLUM, MARJON APRIL (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARJON
Middle Name:APRIL
Last Name:BLUM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 15TH ST
Mailing Address - Street 2:UNIT 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W 15TH ST
Practice Address - Street 2:UNIT 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3723
Practice Address - Country:US
Practice Address - Phone:254-338-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist