MEDICARE: MS. TIFFANY POWERS-REID OTR/L

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	225XP0200X	Pediatric Occupational Therapist	056.005043	IL

General Provider Information

NPI Number	:	1750631123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY POWERS-REID OTR/L

Provider Business Mailing Address
First Line	:	4429 S BERKELEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3609
Country	:	US
Telephone Number	:	773-507-5076
Fax Number	:

Provider Business Practice Location Address
First Line	:	4429 S BERKELEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3609
Country	:	US
Telephone Number	:	773-507-5076
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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