Provider Demographics
NPI:1063526598
Name:JENNINGS, MEGHAN M (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:M
Last Name:JENNINGS
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 1:9556 S SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2013
Mailing Address - Country:US
Mailing Address - Phone:773-259-1272
Mailing Address - Fax:773-233-9950
Practice Address - Street 1:9556 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2013
Practice Address - Country:US
Practice Address - Phone:773-259-1272
Practice Address - Fax:773-233-9950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05600005991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634912OtherBLUE CROSS BLUE SHIELD #