MEDICARE: MRS. CHERYL LARAYNE RENNELLS-LANNOYE OT

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	225X00000X	IL

General Provider Information

NPI Number	:	1952624710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL LARAYNE RENNELLS-LANNOYE OT

Provider Business Mailing Address
First Line	:	27825 IRMA LEE CIR
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-5125
Country	:	US
Telephone Number	:	847-367-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	27825 IRMA LEE CIR
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-5125
Country	:	US
Telephone Number	:	847-367-6555
Fax Number	:

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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