MEDICARE: DANA MARIE GIANCARLO M.S., 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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1245796036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA MARIE GIANCARLO M.S., OTR/L

Provider Business Mailing Address
First Line	:	1036 N HONORE ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 N HONORE ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3716
Country	:	US
Telephone Number	:	708-308-9266
Fax Number	:

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

Provider Enumeration Date	:	02/16/2019
Last Update Date	:	03/02/2023

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