MEDICARE: JOSEPHINE PADILLA OTR

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	056.002068	IL

General Provider Information

NPI Number	:	1417121567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE PADILLA OTR

Provider Business Mailing Address
First Line	:	PO BOX 147322
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7322
Country	:	US
Telephone Number	:	773-472-7253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1503
Country	:	US
Telephone Number	:	773-244-0005
Fax Number	:

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

Provider Enumeration Date	:	04/19/2008
Last Update Date	:	04/22/2008

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