MEDICARE: DAWN CARRIEL

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	056-007423	IL

General Provider Information

NPI Number	:	1366537268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN CARRIEL

Provider Business Mailing Address
First Line	:	6839 S SAINT LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-4022
Country	:	US
Telephone Number	:	773-818-8764
Fax Number	:	773-947-0828

Provider Business Practice Location Address
First Line	:	6839 S SAINT LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-4022
Country	:	US
Telephone Number	:	773-818-8764
Fax Number	:	773-947-0828

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/26/2015

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Directions to “ DAWN CARRIEL ” Practice Location

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