MEDICARE: MARGARITA MORENO

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
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1013418680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARITA MORENO

Provider Business Mailing Address
First Line	:	3731 WESLEY AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-4025
Country	:	US
Telephone Number	:	773-680-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3731 WESLEY AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-4025
Country	:	US
Telephone Number	:	773-680-1201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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Directions to “ MARGARITA MORENO ” Practice Location

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