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NPI Code Detail

MEDICARE: BAILEY MITTMAN

MEDICARE: BAILEY MITTMAN
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
1225X00000XOccupational Therapist056012731IL

General Provider Information

NPI Number : 1356901425
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY MITTMAN
Provider Business Mailing Address
First Line : PO BOX 47949
Second Line :
City : CHICAGO
State : IL
Zip : 60647-7218
Country : US
Telephone Number : 312-458-9865
Fax Number :
Provider Business Practice Location Address
First Line : 3048 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6624
Country : US
Telephone Number : 312-458-9865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2019
Last Update Date : 06/19/2019

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Directions to “ BAILEY MITTMAN ” Practice Location

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