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NPI Code Detail

MEDICARE: CANDACE BUGGS MOTR/L

MEDICARE: CANDACE BUGGS MOTR/L
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 Therapist056.007619IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1056.007619OTHERILOCCUPATIONAL THERAPIST LICENSE

General Provider Information

NPI Number : 1225358062
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE BUGGS MOTR/L
Provider Business Mailing Address
First Line : 4538 N BEACON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5519
Country : US
Telephone Number : 773-275-7200
Fax Number :
Provider Business Practice Location Address
First Line : 4538 N BEACON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5519
Country : US
Telephone Number : 773-275-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2010
Last Update Date : 04/14/2011

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Directions to “ CANDACE BUGGS MOTR/L” Practice Location

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