MEDICARE: SAMANTHA KLEIN 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	056009544	IL

General Provider Information

NPI Number	:	1386999811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KLEIN OTR/L

Provider Business Mailing Address
First Line	:	1133 N DEARBORN ST
Second Line	:	1502
City	:	CHICAGO
State	:	IL
Zip	:	60610-2783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N DEARBORN ST
Second Line	:	1502
City	:	CHICAGO
State	:	IL
Zip	:	60610-2783
Country	:	US
Telephone Number	:	847-903-5955
Fax Number	:

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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