Individual
MRS. GABRIELA JACQUEZ-JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7250
(312) 403-0883
Mailing address
1740 W TAYLOR ST, CHICAGO, IL 60612-7250
(312) 403-0883
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001651
IL
Other
Enumeration date
12/16/2009
Last updated
12/16/2009
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