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NPI Code Detail

MEDICARE: MS. ROBYN REISE MS, OTR L

MEDICARE:  MS. ROBYN  REISE  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
1225XP0200XPediatric Occupational Therapist056.007421IL

General Provider Information

NPI Number : 1982771440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROBYN REISE MS, OTR L
Provider Business Mailing Address
First Line : 1404 W THORNDALE AVE APT 3W
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3346
Country : US
Telephone Number : 312-869-4504
Fax Number :
Provider Business Practice Location Address
First Line : 4619 N RAVENSWOOD AVE STE 300
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4579
Country : US
Telephone Number : 773-697-7333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 06/21/2024

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