MEDICARE: MRS. RELIN DE LEON MS, 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	225XP0200X	Pediatric Occupational Therapist	056007724	IL

General Provider Information

NPI Number	:	1962764555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RELIN DE LEON MS, OTR/L

Provider Business Mailing Address
First Line	:	5016 N MOZART ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3616
Country	:	US
Telephone Number	:	773-230-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 N MOZART ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3616
Country	:	US
Telephone Number	:	773-230-2864
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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