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NPI Code Detail

MEDICARE: MRS. BONNIE LEE PYATT MOT, OTR.L

MEDICARE: MRS. BONNIE LEE PYATT MOT, 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 TherapistIL

General Provider Information

NPI Number : 1265585194
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONNIE LEE PYATT MOT, OTR.L
Provider Business Mailing Address
First Line : 4061 N SHERIDAN RD APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2088
Country : US
Telephone Number : 708-334-3145
Fax Number :
Provider Business Practice Location Address
First Line : 307 W GRAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60610-4140
Country : US
Telephone Number : 312-238-6861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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