Provider Demographics
NPI:1083047864
Name:MIRANDA, TYMEKA ARTHEIA (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MRS
First Name:TYMEKA
Middle Name:ARTHEIA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4301
Mailing Address - Country:US
Mailing Address - Phone:773-434-8028
Mailing Address - Fax:773-434-8028
Practice Address - Street 1:3521 W 72ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4301
Practice Address - Country:US
Practice Address - Phone:773-434-8028
Practice Address - Fax:773-434-8028
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist