MEDICARE: VICTORIA KLUSS M.S., 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	056009191	IL

General Provider Information

NPI Number	:	1407198401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA KLUSS M.S., OTR/L

Provider Business Mailing Address
First Line	:	1234 W BRYN MAWR AVE
Second Line	:	APT 3
City	:	CHICAGO
State	:	IL
Zip	:	60660-4182
Country	:	US
Telephone Number	:	847-651-9484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 W BRYN MAWR AVE
Second Line	:	APT 3
City	:	CHICAGO
State	:	IL
Zip	:	60660-4182
Country	:	US
Telephone Number	:	847-651-9484
Fax Number	:

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	05/06/2013

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