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General NPI Number Information
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NPI Number | 1699390047
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Entity Type | Individual
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Provider Name | BETHUNA SHIELDS MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1401 SOUTH CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608
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Country | US
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Telephone | 773-522-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 850 DES PLAINES AVE APT 510
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City | FOREST PARK
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State | IL
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Zip | 60130-2069
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Country | US
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Telephone | 630-418-0973
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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 | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | 056008855
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License Number State | IL
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