MEDICARE: MARILYN RYNNING JONES 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	056002120	IL

General Provider Information

NPI Number	:	1407073521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN RYNNING JONES OTR/L

Provider Business Mailing Address
First Line	:	1725 WEST HARRISON STREET
Second Line	:	SUITE 440
City	:	CHICAGO
State	:	IL
Zip	:	60612-3824
Country	:	US
Telephone Number	:	312-563-2454
Fax Number	:	312-563-2222

Provider Business Practice Location Address
First Line	:	1725 WEST HARRISON STREET
Second Line	:	RUSH UNIVERSITY MEDICAL CENTER SUITE 440
City	:	CHICAGO
State	:	IL
Zip	:	60612-3824
Country	:	US
Telephone Number	:	312-563-2454
Fax Number	:	312-563-2222

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/26/2012

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