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NPI Code Detail

MEDICARE: MADELYN VAVRA OT

MEDICARE: MADELYN VAVRA OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist056.016938IL
2225X00000XOccupational Therapist9049-26WI

General Provider Information

NPI Number : 1093679342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELYN VAVRA OT
Provider Business Mailing Address
First Line : 29624 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1296
Country : US
Telephone Number : 815-971-7000
Fax Number : 815-968-4795
Provider Business Practice Location Address
First Line : 5970 CHURCHVIEW DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2574
Country : US
Telephone Number : 815-971-2000
Fax Number : 815-971-9267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 04/30/2026

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