MEDICARE: IRMGARD CONSTANCE OCONNOR OT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0077	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1588774236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMGARD CONSTANCE OCONNOR OT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 PEAK DR
Second Line	:	STE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9037
Country	:	US
Telephone Number	:	702-804-0026
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/10/2015

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