Provider Demographics
NPI:1164135927
Name:PEIXOTO HONORATO, VANESSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PEIXOTO HONORATO
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 1:1235 S PRAIRIE AVE APT 2908
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3407
Mailing Address - Country:US
Mailing Address - Phone:312-982-9806
Mailing Address - Fax:
Practice Address - Street 1:411 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2233
Practice Address - Country:US
Practice Address - Phone:708-524-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics