Provider Demographics
NPI:1376671115
Name:REYES, MARIA ISABEL
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ISABEL
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3515
Mailing Address - Country:US
Mailing Address - Phone:773-805-8314
Mailing Address - Fax:773-523-2520
Practice Address - Street 1:2943 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2753
Practice Address - Country:US
Practice Address - Phone:773-805-8314
Practice Address - Fax:773-523-2520
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL056003500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist