Provider Demographics
NPI:1801145487
Name:DUGAN, JOSEPHINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:DUGAN
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 1:1529 S STATE ST APT 21-A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3109
Mailing Address - Country:US
Mailing Address - Phone:312-613-3995
Mailing Address - Fax:
Practice Address - Street 1:1529 S STATE ST APT 21-A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3109
Practice Address - Country:US
Practice Address - Phone:312-613-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist