MEDICARE: AFFINITY REHAB AND THERAPY SERVICES LLC

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	056007751	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001600736	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1346560349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY REHAB AND THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	6033 N SHERIDAN RD
Second Line	:	SUITE 22E
City	:	CHICAGO
State	:	IL
Zip	:	60660-3003
Country	:	US
Telephone Number	:	773-334-8643
Fax Number	:	773-751-2250

Provider Business Practice Location Address
First Line	:	6033 N SHERIDAN RD
Second Line	:	SUITE 22E
City	:	CHICAGO
State	:	IL
Zip	:	60660-3003
Country	:	US
Telephone Number	:	773-334-8643
Fax Number	:	773-751-2250

Authorized Official
Title or Position	:	SOLE MBR
Name	:	DANIEL G CRAIG
Credential	:	OTR/L
Telephone Number	:	773-334-8643

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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