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NPI Code Detail

MEDICARE: MR. ANWAR ADAMS OT

MEDICARE:  MR. ANWAR  ADAMS  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
1225200000XPhysical Therapy Assistant2057193IL
2225X00000XOccupational Therapist056012069IL

General Provider Information

NPI Number : 1174857262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANWAR ADAMS OT
Provider Business Mailing Address
First Line : 4101 S MICHIGAN AVE APT 305
Second Line :
City : CHICAGO
State : IL
Zip : 60653-2144
Country : US
Telephone Number : 847-630-8640
Fax Number :
Provider Business Practice Location Address
First Line : 1029 DES PLAINES AVE APT 601
Second Line :
City : FOREST PARK
State : IL
Zip : 60130
Country : US
Telephone Number : 847-630-8640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2009
Last Update Date : 08/08/2019

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