Provider Demographics
NPI:1396832275
Name:VAZQUEZ, PATRICIA KALB (OT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KALB
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:RUTH
Other - Last Name:KALB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5446 W PENSACOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1332
Mailing Address - Country:US
Mailing Address - Phone:847-347-0042
Mailing Address - Fax:866-410-9192
Practice Address - Street 1:1620 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6005
Practice Address - Country:US
Practice Address - Phone:312-943-3600
Practice Address - Fax:866-410-9192
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist