MEDICARE: DENISE ADAMS

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	224Z00000X	Occupational Therapy Assistant	057000940	IL

General Provider Information

NPI Number	:	1891079091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ADAMS

Provider Business Mailing Address
First Line	:	9217 S. KEDZIE
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805
Country	:	US
Telephone Number	:	312-636-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	9217 S. KEDZIE
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805
Country	:	US
Telephone Number	:	312-636-5289
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/06/2011

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