MEDICARE: LITCHY OCCUPATIONAL THERAPY SERVICES

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	056004424	IL

General Provider Information

NPI Number	:	1275641375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITCHY OCCUPATIONAL THERAPY SERVICES

Provider Business Mailing Address
First Line	:	5127 N DAMEN AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3558
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:	773-944-5784

Provider Business Practice Location Address
First Line	:	5127 N DAMEN AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3558
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:	773-944-5784

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/ OWNER
Name	:	MRS. ANN-MARIE HOTARY
Credential	:	OTR L
Telephone Number	:	773-294-0790

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	08/13/2009

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