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NPI Code Detail

MEDICARE: ELLEN MARIE WARNER

MEDICARE: ELLEN MARIE WARNER
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
1224Z00000XOccupational Therapy Assistant057001621IL

General Provider Information

NPI Number : 1023363132
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN MARIE WARNER
Provider Business Mailing Address
First Line : 1217 WOODBRIDGE ST
Second Line :
City : COLLINSVILLE
State : IL
Zip : 62234-3882
Country : US
Telephone Number : 618-580-8976
Fax Number : 618-345-5904
Provider Business Practice Location Address
First Line : 601 W LINCOLN AVE
Second Line :
City : CASEYVILLE
State : IL
Zip : 62232-1306
Country : US
Telephone Number : 618-344-9355
Fax Number : 618-344-9356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2012
Last Update Date : 07/16/2012

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