Individual
SANDRA JO FORTMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., OTRL
Contact information
Practice address
1234 HUNTERS RDG E, HOFFMAN ESTATES, IL 60192-4541
(847) 429-9615
(847) 429-9615
Mailing address
1234 HUNTERS RDG E, HOFFMAN ESTATES, IL 60192-4541
(847) 429-9615
(847) 429-9615
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634781
BLUE SHIELD PROVIDER NUMB
IL
Enumeration date
02/03/2007
Last updated
07/08/2007
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