Provider Demographics
NPI:1790897718
Name:ANN, JOYCE (OTRL GCFP)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:ANN
Suffix:
Gender:F
Credentials:OTRL GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2734
Mailing Address - Country:US
Mailing Address - Phone:847-748-8313
Mailing Address - Fax:847-831-1457
Practice Address - Street 1:1454 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2734
Practice Address - Country:US
Practice Address - Phone:847-748-8313
Practice Address - Fax:847-831-1457
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056 000220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1625637OtherBLUE CROSS BLUE SHIELD
IL1625637OtherBLUE CROSS BLUE SHIELD