Individual
MARY ANNE LANDRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
9645 S WESTERN AVE, CHICAGO, IL 60643-1722
(773) 239-2734
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-007516
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056007516
LICENSE
IL
01
—
P00796509
MEDICARE RR
IL
Enumeration date
08/11/2006
Last updated
07/05/2021
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