Provider Demographics
NPI:1598909459
Name:SANTIAGO, BELLA LOPEZ (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BELLA
Middle Name:LOPEZ
Last Name:SANTIAGO
Suffix:
Gender:F
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 1:16325 TANBARK DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1248
Mailing Address - Country:US
Mailing Address - Phone:708-532-5441
Mailing Address - Fax:
Practice Address - Street 1:14601 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2641
Practice Address - Country:US
Practice Address - Phone:708-349-8300
Practice Address - Fax:708-460-5136
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
IL056-000811225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist