MEDICARE: VALARIE MCCONVILLE

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

General Provider Information

NPI Number	:	1033538905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALARIE MCCONVILLE

Provider Business Mailing Address
First Line	:	3057 N PERRYVILLE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8016
Country	:	US
Telephone Number	:	630-965-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 N PERRYVILLE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8016
Country	:	US
Telephone Number	:	630-965-2225
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	10/05/2018

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Directions to “ VALARIE MCCONVILLE ” Practice Location

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