MEDICARE: LINNEA A BEADER MS, 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	103725	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103725	OTHER	MN	MN LICENSURE

General Provider Information

NPI Number	:	1356571293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINNEA A BEADER MS, OTR/L

Provider Business Mailing Address
First Line	:	4321 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1705
Country	:	US
Telephone Number	:	612-730-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2407
Country	:	US
Telephone Number	:	773-687-9442
Fax Number	:

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	05/03/2018

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