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NPI Code Detail

MEDICARE: MRS. VIVIAN ANN PURNELL OTR/L

MEDICARE: MRS. VIVIAN ANN PURNELL 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
1225X00000XOccupational Therapist056-001009IL

General Provider Information

NPI Number : 1962725903
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIVIAN ANN PURNELL OTR/L
Provider Business Mailing Address
First Line : 940 MAPLE RD
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-2061
Country : US
Telephone Number : 708-799-0244
Fax Number : 708-799-1505
Provider Business Practice Location Address
First Line : 940 MAPLE RD
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-2061
Country : US
Telephone Number : 708-799-0244
Fax Number : 708-799-1505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2010
Last Update Date : 03/04/2010

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