MEDICARE: MS. JODY PEDRIANA MSOTRL

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	056007286	IL
2	225X00000X	Occupational Therapist	10061	CA

General Provider Information

NPI Number	:	1497802243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODY PEDRIANA MSOTRL

Provider Business Mailing Address
First Line	:	1960 N LINCOLN PARK W
Second Line	:	UNIT 2101
City	:	CHICAGO
State	:	IL
Zip	:	60614-5487
Country	:	US
Telephone Number	:	773-327-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 N CHILDRENS PLZ
Second Line	:	# 142
City	:	CHICAGO
State	:	IL
Zip	:	60614-3363
Country	:	US
Telephone Number	:	773-327-2880
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	03/26/2026

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