MEDICARE: COLLEEN T PATTON OTR/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
1	225X00000X	Occupational Therapist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001634327	OTHER	IL	BCBS-IL PROVIER NUMBER

General Provider Information

NPI Number	:	1346356342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN T PATTON OTR/L

Provider Business Mailing Address
First Line	:	10935 S ARTESIAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1208
Country	:	US
Telephone Number	:	773-236-6581
Fax Number	:

Provider Business Practice Location Address
First Line	:	10935 S ARTESIAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1208
Country	:	US
Telephone Number	:	773-236-6581
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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Directions to “ COLLEEN T PATTON OTR/L” Practice Location

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