MEDICARE: NORTH SHORE PEDIATRIC THERAPY

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1437359189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	1307 WAUKEGAN RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-3070
Country	:	US
Telephone Number	:	847-942-2187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 OLD SKOKIE RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3032
Country	:	US
Telephone Number	:	847-486-4140
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MRS. DEBORAH MICHAEL
Credential	:	OTR/L
Telephone Number	:	847-486-4140

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/30/2007

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