Healthcare Provider Details

I. General information

NPI: 1457237125
Provider Name (Legal Business Name): MARIA LUNA MEDLICOTT MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W LAKE ST
ADDISON IL
60101-2205
US

IV. Provider business mailing address

24014 W RENWICK RD STE 206
PLAINFIELD IL
60544-8711
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-4378
  • Fax: 630-515-1536
Mailing address:
  • Phone: 800-974-4378
  • Fax: 630-515-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.016774
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056-016774
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: