Basic Information
| Provider Information | |||||||||
| NPI: | 1871755983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNGAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTR, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5875 E RIVERSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611144937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153817431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1435 N RANDALL RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601232302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153989491 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2006016938 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 1702362 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 056011068 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 151100015 | 01 | MO | AREA 99 | OTHER |