Provider Demographics
NPI:1225151517
Name:TORRES, EDRALYN
Entity Type:Individual
Prefix:MRS
First Name:EDRALYN
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDRALYN
Other - Middle Name:
Other - Last Name:GRZEGORCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3929 N ASHLAND AVE
Mailing Address - Street 2:UNIT # 4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2507
Mailing Address - Country:US
Mailing Address - Phone:847-962-5678
Mailing Address - Fax:
Practice Address - Street 1:10 EXECUTIVE CT
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9506
Practice Address - Country:US
Practice Address - Phone:847-962-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist