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NPI Code Detail

MEDICARE: KAREN CONNELLY DT

MEDICARE: KAREN CONNELLY DT
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
1174400000XSpecialist

General Provider Information

NPI Number : 1992811582
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN CONNELLY DT
Provider Business Mailing Address
First Line : 14201 LINDER AVE
Second Line :
City : MIDLOTHIAN
State : IL
Zip : 60445-2121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1620 N LASALLE ST
Second Line : ICG REHAB SERVICES
City : CHICAGO
State : IL
Zip : 60614-6005
Country : US
Telephone Number : 312-943-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 04/18/2011

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