MEDICARE: ABIGAIL ROSE WILLINGER DOT

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	106S00000X	Behavior Technician	RBT-17-34056	IL
2	225XP0200X	Pediatric Occupational Therapist	056015790	IL

General Provider Information

NPI Number	:	1497243869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ROSE WILLINGER DOT

Provider Business Mailing Address
First Line	:	2309 KEYSTONE AVE
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1334
Country	:	US
Telephone Number	:	708-284-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 KEYSTONE AVE
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1334
Country	:	US
Telephone Number	:	708-284-1900
Fax Number	:

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

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	11/27/2023

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