MEDICARE: AUDREY D MAEL 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	056001338	IL

General Provider Information

NPI Number	:	1346490760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY D MAEL OTR/L

Provider Business Mailing Address
First Line	:	6032 N LAWNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3112
Country	:	US
Telephone Number	:	773-814-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	6032 N LAWNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3112
Country	:	US
Telephone Number	:	773-814-8866
Fax Number	:

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	09/22/2008

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