Provider Demographics
NPI:1164864344
Name:MAAS, DENISE ELLYN (MOTR:/L)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ELLYN
Last Name:MAAS
Suffix:
Gender:F
Credentials:MOTR:/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9559 S CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1203
Mailing Address - Country:US
Mailing Address - Phone:773-519-0045
Mailing Address - Fax:
Practice Address - Street 1:9559 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1203
Practice Address - Country:US
Practice Address - Phone:773-519-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005610225X00000X
IN31003102A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist