MEDICARE: AUTISM INTERVENTIONS, INC.

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	222Q00000X	Developmental Therapist	TC92450503P	IL

General Provider Information

NPI Number	:	1962716365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM INTERVENTIONS, INC.

Provider Business Mailing Address
First Line	:	3921 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3619
Country	:	US
Telephone Number	:	630-886-8375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3619
Country	:	US
Telephone Number	:	630-886-8375
Fax Number	:

Authorized Official
Title or Position	:	DEVELOPMENTAL THERAPIST
Name	:	TINA M CROSS
Credential	:	D.T.
Telephone Number	:	630-886-8375

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	07/28/2010

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