Provider Demographics
NPI:1932984861
Name:DYDUCH, ANNA MAGDALENA (OTD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MAGDALENA
Last Name:DYDUCH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINDERMERE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5807
Mailing Address - Country:US
Mailing Address - Phone:312-685-9173
Mailing Address - Fax:
Practice Address - Street 1:1224 S HIGH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7724
Practice Address - Country:US
Practice Address - Phone:605-225-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-10466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist