Provider Demographics
NPI:1942325733
Name:DEKOVEN, RONNA (OTR L)
Entity Type:Individual
Prefix:MS
First Name:RONNA
Middle Name:
Last Name:DEKOVEN
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 1:1165 BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1265
Mailing Address - Country:US
Mailing Address - Phone:847-977-9136
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 402
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2269
Practice Address - Country:US
Practice Address - Phone:847-877-5210
Practice Address - Fax:847-510-0430
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-000076225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617235OtherBLUE CROSS BLUE SHIELD