Provider Demographics
NPI:1093143349
Name:MCNIECE, MARJORIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MCNIECE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3726
Mailing Address - Country:US
Mailing Address - Phone:773-763-0660
Mailing Address - Fax:
Practice Address - Street 1:6363 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3726
Practice Address - Country:US
Practice Address - Phone:773-763-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015977-1225X00000X
NJ46TR00539200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist