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Individual

CANDACE BUGGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MOTR/L

Contact information

Practice address
4538 N BEACON ST, CHICAGO, IL 60640-5519
(773) 275-7200
Mailing address
4538 N BEACON ST, CHICAGO, IL 60640-5519
(773) 275-7200

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.007619
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
056.007619
OCCUPATIONAL THERAPIST LICENSE
IL
Enumeration date
06/03/2010
Last updated
04/14/2011
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