MEDICARE: POWER TO LEARN

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
1	225X00000X	Occupational Therapist	05600167	IL

General Provider Information

NPI Number	:	1205066966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWER TO LEARN

Provider Business Mailing Address
First Line	:	15357 W WILDWOOD CT
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-1496
Country	:	US
Telephone Number	:	847-370-8729
Fax Number	:	847-557-9811

Provider Business Practice Location Address
First Line	:	15357 W WILDWOOD CT
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-1496
Country	:	US
Telephone Number	:	847-370-8729
Fax Number	:	847-557-9811

Authorized Official
Title or Position	:	BILLING SERVICE
Name	:	KARIN RICHTER
Credential	:
Telephone Number	:	847-769-5316

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

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Directions to “POWER TO LEARN ” Practice Location

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