Provider Demographics
NPI:1659700649
Name:CASTILLO, DALLAS (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DALLAS
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 N GREENVIEW AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2372
Mailing Address - Country:US
Mailing Address - Phone:815-666-2506
Mailing Address - Fax:
Practice Address - Street 1:1318 N GREENVIEW AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2372
Practice Address - Country:US
Practice Address - Phone:815-666-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist