MEDICARE: MS. WINNIE WAMBUI MUKUHA 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	056008016	IL

General Provider Information

NPI Number	:	1043590698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WINNIE WAMBUI MUKUHA OTR/L

Provider Business Mailing Address
First Line	:	573 DARLINGTON LN
Second Line	:	APT5
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7742
Country	:	US
Telephone Number	:	815-451-7281
Fax Number	:	815-893-0039

Provider Business Practice Location Address
First Line	:	573 DARLINGTON LN
Second Line	:	APT5
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7742
Country	:	US
Telephone Number	:	815-451-7281
Fax Number	:	815-893-0039

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

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	09/28/2011

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