=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487974069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLENE BUFORD-HINES MOTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2010
-----------------------------------------------------
Last Update Date | 06/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 S AUSTIN BLVD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60644-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-287-9181
-----------------------------------------------------
Fax | 773-921-4232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11161 S LONGWOOD DR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60643-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-779-9350
-----------------------------------------------------
Fax | 773-779-9840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 056.007510
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------