Individual
JESSICA GUZMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3156 S KOMENSKY AVE, CHICAGO, IL 60623-4913
(773) 698-4156
Mailing address
66 W OAK ST, CHICAGO, IL 60610-7325
(312) 705-6700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004993
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
IL
Enumeration date
02/11/2019
Last updated
02/11/2019
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