MEDICARE: MRS. DANA MARIE THORNTON M.A.T.

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1316207434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA MARIE THORNTON M.A.T.

Provider Business Mailing Address
First Line	:	7241 S OGLESBY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2517
Country	:	US
Telephone Number	:	312-363-7254
Fax Number	:

Provider Business Practice Location Address
First Line	:	7241 S OGLESBY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2517
Country	:	US
Telephone Number	:	312-363-7254
Fax Number	:

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

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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