MEDICARE: MS. DARCY A STACK MS, OTRL

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	056.006455	IL

General Provider Information

NPI Number	:	1679774525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARCY A STACK MS, OTRL

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 N LASALLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-1206
Country	:	US
Telephone Number	:	312-855-9206
Fax Number	:	312-855-9210

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/13/2011

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