Provider Demographics
NPI:1861032971
Name:MCMAHON, TERESE MAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:MAE
Last Name:MCMAHON
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 1:402 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8546
Mailing Address - Country:US
Mailing Address - Phone:847-505-6565
Mailing Address - Fax:
Practice Address - Street 1:311 W DEPOT ST STE N
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1500
Practice Address - Country:US
Practice Address - Phone:847-838-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056013407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist