MEDICARE: DAVID ROBERT LENNIE O.T.

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	056011373	IL

General Provider Information

NPI Number	:	1770942948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERT LENNIE O.T.

Provider Business Mailing Address
First Line	:	2343 W HIRSCH ST
Second Line	:	#3
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	708-997-0833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 W HIRSCH ST
Second Line	:	#3
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	708-997-0833
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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