MEDICARE: MRS. KATHLEEN MARIE DAHM OTRL CHT

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	000277	MO

General Provider Information

NPI Number	:	1578673521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE DAHM OTRL CHT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8005 W FLORISSANT AVE
Second Line	:	STE L
City	:	JENNINGS
State	:	MO
Zip	:	63136-1452
Country	:	US
Telephone Number	:	314-833-1000
Fax Number	:	314-833-1001

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/13/2016

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