MEDICARE: MADALYN SUE O'REILLY 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
1	225X00000X	Occupational Therapist	107343	MN

General Provider Information

NPI Number	:	1013780857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADALYN SUE O'REILLY OTR/L

Provider Business Mailing Address
First Line	:	1939 MINNEHAHA AVE W STE 300
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1033
Country	:	US
Telephone Number	:	651-748-4338
Fax Number	:	651-748-2892

Provider Business Practice Location Address
First Line	:	1605 HERITAGE DR STE 369
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-3265
Country	:	US
Telephone Number	:	651-433-1918
Fax Number	:	952-683-1746

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	12/19/2023

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