MEDICARE: ABAGAIL WETZEL

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	056.013241	IL

General Provider Information

NPI Number	:	1881278273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABAGAIL WETZEL

Provider Business Mailing Address
First Line	:	3262 EDGEWATER DR
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-8253
Country	:	US
Telephone Number	:	815-263-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 LARAMIE AVE
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1325
Country	:	US
Telephone Number	:	708-687-3334
Fax Number	:

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

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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Directions to “ ABAGAIL WETZEL ” Practice Location

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