Provider Demographics
NPI:1861854994
Name:POPOVA, EVGUENIA SERGEEVNA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EVGUENIA
Middle Name:SERGEEVNA
Last Name:POPOVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 N LAWNDALE AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4151
Mailing Address - Country:US
Mailing Address - Phone:408-506-1933
Mailing Address - Fax:
Practice Address - Street 1:3817 N LAWNDALE AVE APT 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4151
Practice Address - Country:US
Practice Address - Phone:408-506-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist