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NPI Code Detail

MEDICARE: MRS. MARY THERESA JANUS OTR/L

MEDICARE:  MRS. MARY THERESA JANUS  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
1225X00000XOccupational Therapist056.007607IL

General Provider Information

NPI Number : 1134667041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY THERESA JANUS OTR/L
Provider Business Mailing Address
First Line : 7262 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3626
Country : US
Telephone Number : 773-792-7930
Fax Number :
Provider Business Practice Location Address
First Line : 7262 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3626
Country : US
Telephone Number : 773-792-7930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2017
Last Update Date : 02/10/2017

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Directions to “ MRS. MARY THERESA JANUS OTR/L” Practice Location

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