MEDICARE: ELAINE RENEE PANEK 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	056002618	IL

General Provider Information

NPI Number	:	1891067278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE RENEE PANEK OTR

Provider Business Mailing Address
First Line	:	3926 N GALENA AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1202
Country	:	US
Telephone Number	:	847-259-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	3926 N GALENA AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1202
Country	:	US
Telephone Number	:	847-259-0962
Fax Number	:

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

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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