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NPI Code Detail

MEDICARE: RITA MCMAHON DT

MEDICARE:   RITA  MCMAHON  DT
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1689795502
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA MCMAHON DT
Provider Business Mailing Address
First Line : 2010 W ARTHUR AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-5548
Country : US
Telephone Number : 773-844-9677
Fax Number : 773-248-9206
Provider Business Practice Location Address
First Line : 2010 W ARTHUR AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-5548
Country : US
Telephone Number : 773-844-9677
Fax Number : 773-248-9206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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