MEDICARE: MS. MARIE DOYLE 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	174400000X	Specialist	056.010848	IL

General Provider Information

NPI Number	:	1366839912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE DOYLE OTR/L

Provider Business Mailing Address
First Line	:	2203 CENTRAL ST
Second Line	:	APT. 1
City	:	EVANSTON
State	:	IL
Zip	:	60201-5718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 CENTRAL ST
Second Line	:	APT. 1
City	:	EVANSTON
State	:	IL
Zip	:	60201-5718
Country	:	US
Telephone Number	:	847-859-6912
Fax Number	:

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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