Provider Demographics
NPI:1134656887
Name:BORRECA, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:BORRECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W EVERGREEN AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2682
Mailing Address - Country:US
Mailing Address - Phone:312-242-1665
Mailing Address - Fax:
Practice Address - Street 1:811 W EVERGREEN AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2682
Practice Address - Country:US
Practice Address - Phone:312-242-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist