MEDICARE: MRS. PATRICIA KALB VAZQUEZ OT

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		IL
2	225XP0200X	Pediatric Occupational Therapist		IL

General Provider Information

NPI Number	:	1396832275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA KALB VAZQUEZ OT

Provider Business Mailing Address
First Line	:	5446 W PENSACOLA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1332
Country	:	US
Telephone Number	:	847-347-0042
Fax Number	:	866-410-9192

Provider Business Practice Location Address
First Line	:	1620 N LASALLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6005
Country	:	US
Telephone Number	:	312-943-3600
Fax Number	:	866-410-9192

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/30/2007

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