Provider Demographics
NPI:1295184836
Name:MIRANDA WORKS
Entity type:Organization
Organization Name:MIRANDA WORKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYMEKA
Authorized Official - Middle Name:ARTHEIA
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-315-7505
Mailing Address - Street 1:3521 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4301
Mailing Address - Country:US
Mailing Address - Phone:773-315-7505
Mailing Address - Fax:773-424-8207
Practice Address - Street 1:3521 W 72ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4301
Practice Address - Country:US
Practice Address - Phone:773-315-7505
Practice Address - Fax:773-424-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty