MEDICARE: MARGARET MARY UNDERWOOD DT

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	222Q00000X	Developmental Therapist	MU53630107P	IL

General Provider Information

NPI Number	:	1104087816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET MARY UNDERWOOD DT

Provider Business Mailing Address
First Line	:	10156 HYACINTH DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3046
Country	:	US
Telephone Number	:	708-460-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	10156 HYACINTH DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3046
Country	:	US
Telephone Number	:	708-460-8559
Fax Number	:

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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