Individual
MRS. NANCY LYNN RUGGLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
3100 N 77TH AVE, ELMWOOD PARK, IL 60707-1111
(708) 395-5073
(708) 395-5235
Mailing address
3100 N 77TH AVE, ELMWOOD PARK, IL 60707-1111
(708) 395-5073
(708) 395-5235
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056-006828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636470
BLUE CROSS PROVIDER #
IL
Enumeration date
11/25/2006
Last updated
08/09/2010
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