Basic Information
| Provider Information | |||||||||
| NPI: | 1295891885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONOVAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 OGDEN AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309783800 | ||||||||
| FaxNumber: | 6308623083 | ||||||||
| Practice Location | |||||||||
| Address1: | 2111 OGDEN AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309783800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056003239 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 056-003239 | 01 | IL | OT STATE LICENSE # | OTHER |