MEDICARE: TRACI PARTMAN

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1336612027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI PARTMAN

Provider Business Mailing Address
First Line	:	10040 MINNICK AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3871
Country	:	US
Telephone Number	:	708-805-8279
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 MINNICK AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3871
Country	:	US
Telephone Number	:	708-805-8279
Fax Number	:

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

Provider Enumeration Date	:	01/06/2019
Last Update Date	:	01/06/2019

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Directions to “ TRACI PARTMAN ” Practice Location

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