MEDICARE: ELANIE GAIL BERTHEL

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	224Z00000X	Occupational Therapy Assistant	057.006295	IL

General Provider Information

NPI Number	:	1699639104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELANIE GAIL BERTHEL

Provider Business Mailing Address
First Line	:	6320 159TH ST STE F
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320 159TH ST STE F
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2780
Country	:	US
Telephone Number	:	708-466-3347
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ ELANIE GAIL BERTHEL ” Practice Location

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