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NPI Code Detail

MEDICARE: MRS. ROSEANN MISHECK OTR/L

MEDICARE: MRS. ROSEANN MISHECK 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
1225XP0200XPediatric Occupational Therapist056.002221IL

General Provider Information

NPI Number : 1932429859
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROSEANN MISHECK OTR/L
Provider Business Mailing Address
First Line : 19100 CRESCENT DR STE 101
Second Line :
City : MOKENA
State : IL
Zip : 60448-7526
Country : US
Telephone Number : 708-478-5400
Fax Number : 708-478-5300
Provider Business Practice Location Address
First Line : 19100 CRESCENT DR STE 101
Second Line :
City : MOKENA
State : IL
Zip : 60448-7526
Country : US
Telephone Number : 708-478-5400
Fax Number : 708-478-5300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2010
Last Update Date : 06/02/2010

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Directions to “ MRS. ROSEANN MISHECK OTR/L” Practice Location

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