Individual
PAULINA VIVANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1749 N WELLS ST, CHICAGO, IL 60614-5877
(312) 440-9646
Mailing address
1749 N WELLS ST, CHICAGO, IL 60614-5877
(312) 440-9646
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057006241
IL
Other
Enumeration date
11/12/2025
Last updated
11/12/2025
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