MEDICARE: HANNAH MARQUEZ OTD, 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	225XE0001X	Environmental Modification Occupational Therapist
2	225X00000X	Occupational Therapist		IL

General Provider Information

NPI Number	:	1770349771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MARQUEZ OTD, OTR/L

Provider Business Mailing Address
First Line	:	5140 N OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 N OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1847
Country	:	US
Telephone Number	:	616-633-3237
Fax Number	:

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

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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