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General NPI Number Information
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NPI Number | 1447707757
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Entity Type | Individual
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Provider Name | TORENCE WELCH
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Gender | Male
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 5520 LINCOLN AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-3416
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Country | US
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Telephone | 847-583-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 N KILBOURN AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60639-1910
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Country | US
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Telephone |
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057004423
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License Number State | IL
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