MEDICARE: MRS. CAROL MARGARET MOLYNEUX OTRL OCCUPATIONAL TH

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

General Provider Information

NPI Number	:	1720166861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL MARGARET MOLYNEUX OTRL OCCUPATIONAL TH

Provider Business Mailing Address
First Line	:	6749 LAKERIDGE DR
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047
Country	:	US
Telephone Number	:	847-949-7062
Fax Number	:	847-919-7062

Provider Business Practice Location Address
First Line	:	6749 LAKE RIDGE DR
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047
Country	:	US
Telephone Number	:	847-949-7062
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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