Provider Demographics
NPI:1821643180
Name:BARRIENTOS, IRIS G (COTA/L)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:G
Last Name:BARRIENTOS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5519
Mailing Address - Country:US
Mailing Address - Phone:773-275-7200
Mailing Address - Fax:
Practice Address - Street 1:1756 W ROSEHILL DR APT 1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3933
Practice Address - Country:US
Practice Address - Phone:773-807-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004996224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant