Provider Demographics
NPI:1255945531
Name:DUARTE PARRA, LAURA ELENA (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELENA
Last Name:DUARTE PARRA
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 1:2518 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1743
Mailing Address - Country:US
Mailing Address - Phone:773-517-4380
Mailing Address - Fax:
Practice Address - Street 1:2400 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3936
Practice Address - Country:US
Practice Address - Phone:773-389-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-20-132959106S00000X
IL056015389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician