Provider Demographics
NPI:1649473521
Name:MARYANN L MAHER OTRL LTD
Entity type:Organization
Organization Name:MARYANN L MAHER OTRL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:708-923-1332
Mailing Address - Street 1:7804 COLLEGE DRIVE
Mailing Address - Street 2:SUITE 1 S.W.
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1060
Mailing Address - Country:US
Mailing Address - Phone:708-923-1332
Mailing Address - Fax:708-923-1263
Practice Address - Street 1:7804 COLLEGE DRIVE
Practice Address - Street 2:SUITE 1 S.W.
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1060
Practice Address - Country:US
Practice Address - Phone:708-923-1332
Practice Address - Fax:708-923-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy