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General NPI Number Information
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NPI Number | 1093938375
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Entity Type | Individual
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Provider Name | MARY JOSEPHINE BIRCH MT-BC, DTS, CIMI
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18W233 KNOLLWOOD LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3634
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Country | US
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Telephone | 630-953-2821
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Fax | 630-953-9831
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Provider Business Mailing Address
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Address Line | 18W233 KNOLLWOOD LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3634
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Country | US
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Telephone | 630-953-2821
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Fax | 630-953-9831
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | MB49860101P
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License Number State | IL
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