Basic Information
| Provider Information | |||||||||
| NPI: | 1881807188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.S. OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474864140 | ||||||||
| FaxNumber: | 8474864145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474864140 | ||||||||
| FaxNumber: | 8474864145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.007898 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.