=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629463211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY MCELLEN MOT OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2015
-----------------------------------------------------
Last Update Date | 04/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 S RIVERSIDE PLZ STE 830
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60606-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-386-0773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1232 PARK AVE
-----------------------------------------------------
City | WINTHROP HARBOR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60096-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-619-6822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 056.010952
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------