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NPI Code Detail

MEDICARE: REAGAN LOCKWOOD MOT, OTR/L

MEDICARE: REAGAN LOCKWOOD MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist056012446IL

General Provider Information

NPI Number : 1013410406
Entity Type Code : Individual
Provider Name (Legal Business Name) : REAGAN LOCKWOOD MOT, OTR/L
Provider Business Mailing Address
First Line : 2043 W BELMONT AVE STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6796
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2043 W BELMONT AVE STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6796
Country : US
Telephone Number : 773-332-9439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 03/13/2018

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Directions to “ REAGAN LOCKWOOD MOT, OTR/L” Practice Location

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