MEDICARE: CHRISTINA LAND

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

General Provider Information

NPI Number	:	1700181351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA LAND

Provider Business Mailing Address
First Line	:	3046 W WELLINGTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3046 W WELLINGTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6924
Country	:	US
Telephone Number	:	815-520-1115
Fax Number	:

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

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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Directions to “ CHRISTINA LAND ” Practice Location

Language	Start Address	Practice Location

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