Provider Demographics
NPI:1952350886
Name:OCCUSPORT SERVICES INC.
Entity Type:Organization
Organization Name:OCCUSPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:815-836-3780
Mailing Address - Street 1:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1089
Mailing Address - Country:US
Mailing Address - Phone:815-836-3780
Mailing Address - Fax:
Practice Address - Street 1:420 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3241
Practice Address - Country:US
Practice Address - Phone:815-836-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL567770Medicare ID - Type UnspecifiedMEDICRE GROUP NUMBER
IL205256Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL200852Medicare ID - Type UnspecifiedMEDICRE GROUP NUMBER