MEDICARE: MRS. YVONNE M CIKANEK 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	056.009701	IL

General Provider Information

NPI Number	:	1841670312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE M CIKANEK OTR/L

Provider Business Mailing Address
First Line	:	823 N RIDGELAND AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1439
Country	:	US
Telephone Number	:	773-558-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	4058 W MELROSE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4799
Country	:	US
Telephone Number	:	773-481-5716
Fax Number	:

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

Provider Enumeration Date	:	05/31/2015
Last Update Date	:	05/31/2015

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