MEDICARE: MADISON VOLPERT OTD

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	056014231	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	056014231	OTHER	IL	DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1659035939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON VOLPERT OTD

Provider Business Mailing Address
First Line	:	1523 E WALNUT ST
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-1541
Country	:	US
Telephone Number	:	217-317-3193
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 GREENHEAD DR STE D
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7426
Country	:	US
Telephone Number	:	217-891-1524
Fax Number	:	855-246-2163

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

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	10/24/2021

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Directions to “ MADISON VOLPERT OTD” Practice Location

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