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NPI Code Detail

MEDICARE: MARIYA NIKOLOVA PASHOVA

MEDICARE: MARIYA NIKOLOVA PASHOVA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1689122822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIYA NIKOLOVA PASHOVA
Provider Business Mailing Address
First Line : 1062 W BRYN MAWR AVE
Second Line : APT 412
City : CHICAGO
State : IL
Zip : 60660-4602
Country : US
Telephone Number : 773-727-9530
Fax Number :
Provider Business Practice Location Address
First Line : 633 W ADDISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-4981
Country : US
Telephone Number : 773-615-3203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2016
Last Update Date : 09/16/2016

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Directions to “ MARIYA NIKOLOVA PASHOVA ” Practice Location

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