MEDICARE: MRS. MARILYN JANE WEBSTER

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	:	1861621849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN JANE WEBSTER

Provider Business Mailing Address
First Line	:	835 W DOUGLAS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1825
Country	:	US
Telephone Number	:	217-245-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 W DOUGLAS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1825
Country	:	US
Telephone Number	:	217-245-2846
Fax Number	:

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

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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