Provider Demographics
NPI:1306188693
Name:PASCHAL, SHARON (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PASCHAL
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 1:2303 W GRANVILLE AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2911
Mailing Address - Country:US
Mailing Address - Phone:312-719-9013
Mailing Address - Fax:773-961-8152
Practice Address - Street 1:2303 W GRANVILLE AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2911
Practice Address - Country:US
Practice Address - Phone:312-719-9013
Practice Address - Fax:773-961-8152
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057000765224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant