MEDICARE: MR. MICHAEL J MAEDER 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113326	OTHER		HEALTHLINK PROV ID
2	203	OTHER	IL	BLUE CROSS PROV ID
3	4117	OTHER	IL	HAMP PROV ID
4	7216	OTHER		PERSONALCARE PROV ID

General Provider Information

NPI Number	:	1588780175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J MAEDER OTR L

Provider Business Mailing Address
First Line	:	611 W PARK ST
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61801-2500
Country	:	US
Telephone Number	:	217-326-2911
Fax Number	:	217-344-8047

Provider Business Practice Location Address
First Line	:	1504 EAST GROVE
Second Line	:
City	:	RANTOUL
State	:	IL
Zip	:	61866-2736
Country	:	US
Telephone Number	:	217-893-7720
Fax Number	:	217-893-7803

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. MICHAEL J MAEDER OTR L” Practice Location

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