Individual
THERESA BANZUELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5320 W FLETCHER ST, CHICAGO, IL 60641-4944
(773) 971-3352
Mailing address
5320 W FLETCHER ST, CHICAGO, IL 60641-4944
(773) 971-3352
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004963
IL
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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