MEDICARE: MARENGO OCCUPATIONAL THERAPY SERVICES, INC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1720328008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARENGO OCCUPATIONAL THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 683
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-0683
Country	:	US
Telephone Number	:	815-568-8878
Fax Number	:	815-568-9977

Provider Business Practice Location Address
First Line	:	212 LINDOW LN
Second Line	:	SUITE M
City	:	MARENGO
State	:	IL
Zip	:	60152-9480
Country	:	US
Telephone Number	:	815-568-8878
Fax Number	:	815-568-9977

Authorized Official
Title or Position	:	PRESIDENT / PHYSICAL THERAPIST
Name	:	MR. JONATHAN S LINK
Credential	:	MPT
Telephone Number	:	815-568-8878

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	02/22/2013

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