MEDICARE: MRS. ROBIN E THEIS 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	056.002255	IL

General Provider Information

NPI Number	:	1972834497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN E THEIS OTR/L

Provider Business Mailing Address
First Line	:	25 NORTH WINFIELD ROAD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190
Country	:	US
Telephone Number	:	630-933-6293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4698 DEPARTMENT
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-0021
Country	:	US
Telephone Number	:	630-933-1600
Fax Number	:

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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