Provider Demographics
NPI:1821277807
Name:BOEKELMAN, PEGGY SUE RADMAKER (OT)
Entity Type:Individual
Prefix:
First Name:PEGGY SUE RADMAKER
Middle Name:
Last Name:BOEKELMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PEGGY SUE
Other - Middle Name:
Other - Last Name:RADMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:490 W LYONS ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1946
Practice Address - Country:US
Practice Address - Phone:641-923-2677
Practice Address - Fax:641-923-0074
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist