MEDICARE: MRS. ANNMARIE HOTARY 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	225XP0200X	Pediatric Occupational Therapist	056004424	IL

General Provider Information

NPI Number	:	1336271261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNMARIE HOTARY OTRL

Provider Business Mailing Address
First Line	:	5127 N DAMEN AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3558
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:	774-944-5784

Provider Business Practice Location Address
First Line	:	5127 N DAMEN AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3558
Country	:	US
Telephone Number	:	773-294-0790
Fax Number	:	774-944-5784

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	08/13/2009

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