MEDICARE: LAURI DEANN MAGUIRE OTA

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		IL

General Provider Information

NPI Number	:	1891342622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURI DEANN MAGUIRE OTA

Provider Business Mailing Address
First Line	:	7325 MEADOWSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60012-2961
Country	:	US
Telephone Number	:	815-451-6393
Fax Number	:

Provider Business Practice Location Address
First Line	:	7325 MEADOWSHIRE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60012-2961
Country	:	US
Telephone Number	:	815-451-6393
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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