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NPI Code Detail

MEDICARE: MATTHEW JAMES OURADNIK OTR

MEDICARE: MATTHEW JAMES OURADNIK OTR
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 Therapist056013376IL

General Provider Information

NPI Number : 1144673500
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JAMES OURADNIK OTR
Provider Business Mailing Address
First Line : 14711 S RAVINIA AVE
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3100
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14711 S RAVINIA AVE
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3100
Country : US
Telephone Number : 815-469-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2016
Last Update Date : 02/08/2020

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