Provider Demographics
NPI:1538367503
Name:BODOR, ALISON M (OTR/L)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:BODOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N COMMONWEALTH AVE
Mailing Address - Street 2:4-G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3447
Mailing Address - Country:US
Mailing Address - Phone:502-552-3492
Mailing Address - Fax:
Practice Address - Street 1:2300 N COMMONWEALTH AVE
Practice Address - Street 2:4-G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3447
Practice Address - Country:US
Practice Address - Phone:502-552-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56007813225X00000X
IN31004031A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist