MEDICARE: MARY BARES

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	056010776	IL

General Provider Information

NPI Number	:	1144842683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BARES

Provider Business Mailing Address
First Line	:	6800 N OZARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1277
Country	:	US
Telephone Number	:	630-479-1132
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 N OZARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1277
Country	:	US
Telephone Number	:	630-479-1132
Fax Number	:

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

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/07/2020

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Directions to “ MARY BARES ” Practice Location

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