Provider Demographics
NPI:1952692626
Name:VASQUEZ, RUTH ESCUETA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ESCUETA
Last Name:VASQUEZ
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 1:3868 N CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2038
Mailing Address - Country:US
Mailing Address - Phone:217-462-0357
Mailing Address - Fax:217-462-0356
Practice Address - Street 1:1495 W KING ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-1444
Practice Address - Country:US
Practice Address - Phone:217-462-0357
Practice Address - Fax:217-462-0356
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist