MEDICARE: HAILEY CHASSON OTR/L

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	056009151	IL

General Provider Information

NPI Number	:	1679875165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY CHASSON OTR/L

Provider Business Mailing Address
First Line	:	3421 N SEMINARY AVE APT 1N
Second Line	:	UNIT C
City	:	CHICAGO
State	:	IL
Zip	:	60657-9036
Country	:	US
Telephone Number	:	773-687-9146
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 NORTH SEMINARY AVENUE
Second Line	:	SUITE 1N
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-480-1720
Fax Number	:

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

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	10/05/2022

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