Provider Demographics
NPI:1942371299
Name:BARRAZA, MARIA ANGELICA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANGELICA
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:BARRAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5716 N JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3616
Mailing Address - Country:US
Mailing Address - Phone:773-914-0123
Mailing Address - Fax:
Practice Address - Street 1:5716 N JERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3616
Practice Address - Country:US
Practice Address - Phone:773-914-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56005840225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL56005840OtherSTATE LICENSE NUMBER