Provider Demographics
NPI:1366163347
Name:DUDGEON, ROSARIA MARIE (OT)
Entity type:Individual
Prefix:MRS
First Name:ROSARIA
Middle Name:MARIE
Last Name:DUDGEON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:ROSARIA
Other - Middle Name:MARIE
Other - Last Name:SCAFIDI DUDGEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:5104 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-3742
Mailing Address - Country:US
Mailing Address - Phone:773-512-1669
Mailing Address - Fax:
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2881
Practice Address - Country:US
Practice Address - Phone:773-282-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005159225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist