MEDICARE: CAROLINE ROSE CHEN MS OTRL

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	056007636	IL

General Provider Information

NPI Number	:	1336214683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ROSE CHEN MS OTRL

Provider Business Mailing Address
First Line	:	242 BILTMORE DR
Second Line	:
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-2004
Country	:	US
Telephone Number	:	847-224-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 BILTMORE DR
Second Line	:
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-2004
Country	:	US
Telephone Number	:	847-224-7767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	09/12/2020

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