Melissa Jayne Banevich-Glaros, OTR/L

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

05605261 Issued in IL

Practice address

19350 Boulder Ridge Dr
Mokena, IL 60448-8238

Phone

(708) 257-1009

NPI assigned

May 8, 2012

Last updated

May 8, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336435200000",
    "number": "1912266149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19350 BOULDER RIDGE DR",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488238",
            "telephone_number": "708-257-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19350 BOULDER RIDGE DR",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488238",
            "telephone_number": "708-257-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANEVICH-GLAROS",
        "first_name": "MELISSA",
        "middle_name": "JAYNE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-08",
        "last_updated": "2012-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "05605261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Mokena, IL
• Providers in Mokena, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.