MEDICARE: EMILY S. FEHRENBACHER 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	2003023235	MO
2	225X00000X	Occupational Therapist	056.008457	IL

General Provider Information

NPI Number	:	1558560854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY S. FEHRENBACHER OTR/L

Provider Business Mailing Address
First Line	:	100 E 14TH ST
Second Line	:	UNIT 2904
City	:	CHICAGO
State	:	IL
Zip	:	60605-2889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 S GILES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1106
Country	:	US
Telephone Number	:	312-326-2000
Fax Number	:

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	05/28/2009

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