Provider Demographics
NPI:1598299570
Name:VILLANUEVA, KARINA K
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:K
Last Name:VILLANUEVA
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 1:9446 DEE RD
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3867
Mailing Address - Country:US
Mailing Address - Phone:904-910-5317
Mailing Address - Fax:
Practice Address - Street 1:675 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3100
Practice Address - Country:US
Practice Address - Phone:847-352-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant