MEDICARE: LEANNE KING BACHELOR

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	056009726	IL

General Provider Information

NPI Number	:	1326382458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE KING BACHELOR

Provider Business Mailing Address
First Line	:	2935 N CLYBOURN AVE
Second Line	:	#302
City	:	CHICAGO
State	:	IL
Zip	:	60618-8187
Country	:	US
Telephone Number	:	217-416-5453
Fax Number	:

Provider Business Practice Location Address
First Line	:	6033 N SHERIDAN RD
Second Line	:	#22E
City	:	CHICAGO
State	:	IL
Zip	:	60660-3003
Country	:	US
Telephone Number	:	217-416-5453
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ LEANNE KING BACHELOR” Practice Location

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