Provider Demographics
NPI:1225337744
Name:HIDALGO, ANGELINO (OT)
Entity Type:Individual
Prefix:MR
First Name:ANGELINO
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 CLINTON AVE
Mailing Address - Street 2:# 3W
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2908
Mailing Address - Country:US
Mailing Address - Phone:773-454-9732
Mailing Address - Fax:
Practice Address - Street 1:3205 CLINTON AVE
Practice Address - Street 2:# 3W
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2908
Practice Address - Country:US
Practice Address - Phone:773-454-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist