Individual
LUIS ALBERTO MACIEL-MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3000 S PULASKI RD, CHICAGO, IL 60623-4458
(773) 475-7651
(773) 475-7564
Mailing address
4516 W 55TH ST, CHICAGO, IL 60632-4722
(773) 691-2640
(773) 475-7564
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004693
IL
Other
Enumeration date
03/18/2017
Last updated
03/18/2017
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