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NPI Code Detail

MEDICARE: MAIYANNIE NECOE HUBBARD

MEDICARE: MAIYANNIE NECOE HUBBARD
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
1224Z00000XOccupational Therapy Assistant

General Provider Information

NPI Number : 1700520210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIYANNIE NECOE HUBBARD
Provider Business Mailing Address
First Line : 6749 JOSEPH AVE
Second Line :
City : PORTAGE
State : IN
Zip : 46368-2696
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4314 S WABASH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3119
Country : US
Telephone Number : 773-217-4840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2022
Last Update Date : 04/21/2022

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Directions to “ MAIYANNIE NECOE HUBBARD ” Practice Location

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