Provider Demographics
NPI:1780026633
Name:ZUPAN, MAUREEN T (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:T
Last Name:ZUPAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 182ND ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1737
Mailing Address - Country:US
Mailing Address - Phone:708-895-6817
Mailing Address - Fax:
Practice Address - Street 1:1846 182ND ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1737
Practice Address - Country:US
Practice Address - Phone:708-895-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003081172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker