Provider Demographics
NPI:1760498299
Name:DARNALL, MARY ANDREE (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANDREE
Last Name:DARNALL
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANDREE
Other - Last Name:DARNALL PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:136 S CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2916
Mailing Address - Country:US
Mailing Address - Phone:708-383-2039
Mailing Address - Fax:708-386-0418
Practice Address - Street 1:136 S CUYLER AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2916
Practice Address - Country:US
Practice Address - Phone:708-383-2039
Practice Address - Fax:708-386-0418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.000740225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics