Provider Demographics
NPI:1831602978
Name:DYZENHAUS, MARIA DANIELLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DANIELLE
Last Name:DYZENHAUS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 N ASHLAND AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2787
Mailing Address - Country:US
Mailing Address - Phone:224-659-2386
Mailing Address - Fax:
Practice Address - Street 1:9400 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1008
Practice Address - Country:US
Practice Address - Phone:847-745-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist