MEDICARE: MS. DANA KAY COMSTOCK

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	:	1871725747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA KAY COMSTOCK

Provider Business Mailing Address
First Line	:	2111 W CHURCHILL ST
Second Line	:	UNIT 209
City	:	CHICAGO
State	:	IL
Zip	:	60647-5534
Country	:	US
Telephone Number	:	773-251-4156
Fax Number	:	773-235-3380

Provider Business Practice Location Address
First Line	:	2111 W CHURCHILL ST
Second Line	:	UNIT 209
City	:	CHICAGO
State	:	IL
Zip	:	60647-5534
Country	:	US
Telephone Number	:	773-251-4156
Fax Number	:	773-235-3380

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

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/11/2009

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