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NPI Code Detail

MEDICARE: JENNIFER SHADDEN O.T

MEDICARE: JENNIFER SHADDEN O.T
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
1225X00000XOccupational TherapistOT 7865CA
2225X00000XOccupational Therapist056.008744IL

General Provider Information

NPI Number : 1083724751
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SHADDEN O.T
Provider Business Mailing Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Provider Business Practice Location Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 08/21/2009

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Directions to “ JENNIFER SHADDEN O.T” Practice Location

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