MEDICARE: MRS. LORI ANN DANIELS

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1821352923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ANN DANIELS

Provider Business Mailing Address
First Line	:	19330 WOODFIELD CT
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-5549
Country	:	US
Telephone Number	:	708-243-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	19330 WOODFIELD CT
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-5549
Country	:	US
Telephone Number	:	708-243-8594
Fax Number	:

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	07/03/2012

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