Provider Demographics
NPI:1518458017
Name:NUNEZ, MARCELLA THERESA (COTA)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:THERESA
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1644
Mailing Address - Country:US
Mailing Address - Phone:708-600-1768
Mailing Address - Fax:
Practice Address - Street 1:3705 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3540
Practice Address - Country:US
Practice Address - Phone:847-947-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant