Individual provider Active NPI

Dana Deanne Fortado, OTR/L

  • Pediatric Occupational Therapist
  • River Forest, IL
National Provider Identifier
1437235041
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Practice address
7350 Lake St
G
River Forest, IL 60305-2247
Phone
(708) 828-0221
Fax
(708) 216-6534
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X IL Primary

Addresses

Primary practice location

7350 Lake St
G
River Forest, IL 60305-2247

Mailing address

7350 Lake St
G
River Forest, IL 60305-2247
Phone (708) 828-0221

Other identifiers 1

IdentifierTypeStateIssuer
0001635382OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
056.003219ILMDPediatric Occupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437235041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7350 LAKE ST",
            "address_2": "G",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603052247",
            "telephone_number": "708-828-0221",
            "fax_number": "708-216-6534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7350 LAKE ST",
            "address_2": "G",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603052247",
            "telephone_number": "708-828-0221",
            "fax_number": "708-216-6534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTADO",
        "first_name": "DANA",
        "middle_name": "DEANNE",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001635382",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in River Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.