Provider Demographics
NPI:1730808627
Name:DORAN, MIRANDA (OT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:DORAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:JOY
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8201 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5314
Mailing Address - Country:US
Mailing Address - Phone:630-590-5571
Mailing Address - Fax:
Practice Address - Street 1:10 SARAVANOS RD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-5814
Practice Address - Country:US
Practice Address - Phone:630-553-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist