Provider Demographics
NPI:1073880829
Name:ALFEREZ, FIONNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:FIONNA
Middle Name:
Last Name:ALFEREZ
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 1:4011 N FRANCISCO AVE
Mailing Address - Street 2:UNIT 309
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2654
Mailing Address - Country:US
Mailing Address - Phone:702-319-1479
Mailing Address - Fax:
Practice Address - Street 1:730 W HINTZ RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5501
Practice Address - Country:US
Practice Address - Phone:847-537-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist