MEDICARE: TAMIKA NICOLE LEWIS

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	224Z00000X	Occupational Therapy Assistant	057003876	IL

General Provider Information

NPI Number	:	1417413485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA NICOLE LEWIS

Provider Business Mailing Address
First Line	:	16300 WAUSAU AVE
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-2158
Country	:	US
Telephone Number	:	708-777-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	20013 LAKEWOOD AVE
Second Line	:
City	:	LYNWOOD
State	:	IL
Zip	:	60411-1515
Country	:	US
Telephone Number	:	708-965-2278
Fax Number	:

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

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	10/12/2020

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Directions to “ TAMIKA NICOLE LEWIS ” Practice Location

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