Provider Demographics
NPI:1093919441
Name:BLOCK, MARY R (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23527 N EAST RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8816
Mailing Address - Country:US
Mailing Address - Phone:847-438-0993
Mailing Address - Fax:847-438-1234
Practice Address - Street 1:23527 N EAST RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-8816
Practice Address - Country:US
Practice Address - Phone:847-438-0993
Practice Address - Fax:847-438-1234
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005720172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist