MEDICARE: MRS. LAURA JEAN SANZANA 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	056006378	IL

General Provider Information

NPI Number	:	1407014764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA JEAN SANZANA OTR/L

Provider Business Mailing Address
First Line	:	24633 W PASSAVANT AVE
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-1462
Country	:	US
Telephone Number	:	847-740-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	24633 W PASSAVANT AVE
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-1462
Country	:	US
Telephone Number	:	847-740-9050
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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