MEDICARE: DONNA JEAN ZINE OTRL

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		IL

General Provider Information

NPI Number	:	1225103658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA JEAN ZINE OTRL

Provider Business Mailing Address
First Line	:	725 GRAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-3007
Country	:	US
Telephone Number	:	630-844-1110
Fax Number	:	630-264-6906

Provider Business Practice Location Address
First Line	:	725 GRAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-3007
Country	:	US
Telephone Number	:	630-844-1110
Fax Number	:	630-264-6906

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DONNA JEAN ZINE OTRL” Practice Location

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