Provider Demographics
NPI:1336285865
Name:PADILLA, ALICIA (OT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 W 38TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-2025
Mailing Address - Country:US
Mailing Address - Phone:773-720-3915
Mailing Address - Fax:773-847-6006
Practice Address - Street 1:1751 W 38TH ST
Practice Address - Street 2:APT. 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-2025
Practice Address - Country:US
Practice Address - Phone:773-720-3915
Practice Address - Fax:773-847-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty