MEDICARE: ERIN LANKE OT

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	056009785	IL

General Provider Information

NPI Number	:	1194060111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN LANKE OT

Provider Business Mailing Address
First Line	:	510 W BELMONT AVE APT 1502
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4631
Country	:	US
Telephone Number	:	414-526-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 W BELMONT AVE APT 1502
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4631
Country	:	US
Telephone Number	:	414-526-1785
Fax Number	:

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

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/03/2012

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Directions to “ ERIN LANKE OT” Practice Location

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