Provider Demographics
NPI:1174198923
Name:DEGUZMAN, MARIBEL (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W 38TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1840
Mailing Address - Country:US
Mailing Address - Phone:317-457-4771
Mailing Address - Fax:
Practice Address - Street 1:502 N STATE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN GROVE
Practice Address - State:IL
Practice Address - Zip Code:61031-9773
Practice Address - Country:US
Practice Address - Phone:815-456-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20418-875225X00000X
IL056013683225X00000X
IL056.013683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist