Provider Demographics
NPI:1922208008
Name:MADDEN-PNIEWSKI, MARY EILEEN (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EILEEN
Last Name:MADDEN-PNIEWSKI
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 INDIANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1130
Mailing Address - Country:US
Mailing Address - Phone:708-877-6402
Mailing Address - Fax:
Practice Address - Street 1:27 INDIANWOOD DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1130
Practice Address - Country:US
Practice Address - Phone:708-877-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist