MEDICARE: MS. TEMPERANCE TOWNSEND

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	222Q00000X	Developmental Therapist	T52581672805	IL

General Provider Information

NPI Number	:	1417347782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEMPERANCE TOWNSEND

Provider Business Mailing Address
First Line	:	511 E 80TH ST
Second Line	:	APT.3
City	:	CHICAGO
State	:	IL
Zip	:	60619-3807
Country	:	US
Telephone Number	:	708-654-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 E 80TH ST
Second Line	:	APT.3
City	:	CHICAGO
State	:	IL
Zip	:	60619-3807
Country	:	US
Telephone Number	:	708-654-7904
Fax Number	:

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

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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