Provider Demographics
NPI:1164276457
Name:MORENO, ARIANA (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:ARIANA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-2632
Mailing Address - Country:US
Mailing Address - Phone:815-764-7008
Mailing Address - Fax:
Practice Address - Street 1:2255 MONARCH DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4164
Practice Address - Country:US
Practice Address - Phone:630-300-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.006087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant