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NPI Code Detail

MEDICARE: MR. PAUL ROBERT BOONE

MEDICARE: MR. PAUL ROBERT BOONE
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
1224Z00000XOccupational Therapy Assistant057002691IL

General Provider Information

NPI Number : 1568731388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL ROBERT BOONE
Provider Business Mailing Address
First Line : 3600 W 120TH ST APT D302
Second Line :
City : ALSIP
State : IL
Zip : 60803-3673
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10300 SOUTHWEST HWY
Second Line :
City : CHICAGO RIDGE
State : IL
Zip : 60415-1426
Country : US
Telephone Number : 708-425-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2011
Last Update Date : 12/22/2011

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