Provider Demographics
NPI:1073640116
Name:MAHER, MARYANN L (OTRL)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:L
Last Name:MAHER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 COLLEGE DRIVE
Mailing Address - Street 2:SUITE 1 S.W.
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-1332
Mailing Address - Fax:708-923-1263
Practice Address - Street 1:7804 COLLEGE DRIVE
Practice Address - Street 2:SUITE 1 S.W.
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-1332
Practice Address - Fax:708-923-1263
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0560022992251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001671508OtherBCBS PROVIDER NUMBER
IL0001671508OtherBCBS PROVIDER NUMBER