Basic Information
| Provider Information | |||||||||
| NPI: | 1538448956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | HALL | ||||||||
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| Credential: | MA/OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 W MELROSE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606185908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737197017 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 6033 N SHERIDAN RD | ||||||||
| Address2: | N6 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606603003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732754800 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056005742 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.