Provider Demographics
NPI:1851508105
Name:PUREVICH, TANYA MARIE (OTR, OT(C))
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:PUREVICH
Suffix:
Gender:F
Credentials:OTR, OT(C)
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:BENTVELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, OT(C)
Mailing Address - Street 1:814 E 38TH PLACE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1999
Mailing Address - Country:US
Mailing Address - Phone:773-938-1128
Mailing Address - Fax:
Practice Address - Street 1:1401 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1858
Practice Address - Country:US
Practice Address - Phone:773-522-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist