MEDICARE: MARGARET KELLY OTR

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	056.009752	IL

General Provider Information

NPI Number	:	1881235919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET KELLY OTR

Provider Business Mailing Address
First Line	:	13544 IDLEWILD DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-1517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 W 113TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4117
Country	:	US
Telephone Number	:	708-261-4093
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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