MEDICARE: MISS MELISSA B OLES

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336447929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA B OLES

Provider Business Mailing Address
First Line	:	2028 W MELROSE ST
Second Line	:	GARDEN
City	:	CHICAGO
State	:	IL
Zip	:	60618-6308
Country	:	US
Telephone Number	:	773-307-9691
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 W MELROSE ST
Second Line	:	GARDEN
City	:	CHICAGO
State	:	IL
Zip	:	60618-6308
Country	:	US
Telephone Number	:	773-307-9691
Fax Number	:

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

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

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