Provider Demographics
NPI:1083248363
Name:ALVAREZ, DANIELA (COTA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 GREENBAY AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5939
Mailing Address - Country:US
Mailing Address - Phone:708-916-5541
Mailing Address - Fax:
Practice Address - Street 1:1309 GREENBAY AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5939
Practice Address - Country:US
Practice Address - Phone:708-916-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005344224Z00000X
IN32003461A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant