Provider Demographics
NPI:1033161252
Name:MAYMON, ESTHERLYN (MPA, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ESTHERLYN
Middle Name:
Last Name:MAYMON
Suffix:
Gender:F
Credentials:MPA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:PMR#117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-7956
Mailing Address - Fax:312-569-8050
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:PM&R #117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-7956
Practice Address - Fax:312-569-7956
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001169225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation