MEDICARE: MS. CATHERINE GEIGHES D.T.

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1639290935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE GEIGHES D.T.

Provider Business Mailing Address
First Line	:	960 S RIVER RD
Second Line	:	#202
City	:	DES PLAINES
State	:	IL
Zip	:	60016-6767
Country	:	US
Telephone Number	:	847-404-4269
Fax Number	:

Provider Business Practice Location Address
First Line	:	7217 W IBSEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1102
Country	:	US
Telephone Number	:	847-404-4269
Fax Number	:	773-631-4643

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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