MEDICARE: MS. NORA ANN MULCHRONE

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	222Q00000X	Developmental Therapist	NM69690101P	IL

General Provider Information

NPI Number	:	1699898494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORA ANN MULCHRONE

Provider Business Mailing Address
First Line	:	2550 W 112TH ST
Second Line	:	UNIT 9
City	:	CHICAGO
State	:	IL
Zip	:	60655-1345
Country	:	US
Telephone Number	:	773-213-0695
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W 112TH ST
Second Line	:	UNIT 9
City	:	CHICAGO
State	:	IL
Zip	:	60655-1345
Country	:	US
Telephone Number	:	773-213-0695
Fax Number	:

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

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	07/08/2007

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