Provider Demographics
NPI:1053866400
Name:RORTVEDT, DANIEL JAMES (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:RORTVEDT
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2909
Mailing Address - Country:US
Mailing Address - Phone:608-513-8664
Mailing Address - Fax:
Practice Address - Street 1:406 BLAINE ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2909
Practice Address - Country:US
Practice Address - Phone:608-513-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist