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Individual

MS. DANA DEANNE FORTADO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
7350 LAKE ST, G, RIVER FOREST, IL 60305-2247
(708) 828-0221
(708) 216-6534
Mailing address
7350 LAKE ST, G, RIVER FOREST, IL 60305-2247
(708) 828-0221
(708) 216-6534

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0001635382
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/27/2006
Last updated
07/08/2007
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