MEDICARE: HEIDI M FALL OTR/L

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	056.003053	IL

General Provider Information

NPI Number	:	1952632481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI M FALL OTR/L

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 HENRY LUCKOW LN
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-1702
Country	:	US
Telephone Number	:	815-544-6967
Fax Number	:

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	10/23/2024

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