Provider Demographics
NPI:1477807972
Name:CODINA, NATHANIEL (OTR-L)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:CODINA
Suffix:
Gender:M
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RANDOLPH ST
Mailing Address - Street 2:APT 1519
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7329
Mailing Address - Country:US
Mailing Address - Phone:773-405-7103
Mailing Address - Fax:
Practice Address - Street 1:2710 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1503
Practice Address - Country:US
Practice Address - Phone:773-244-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist