MEDICARE: MRS. MARIA ANGELICA BARRAZA OTR

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
1	225XP0200X	Pediatric Occupational Therapist	56005840	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56005840	OTHER	IL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1942371299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA ANGELICA BARRAZA OTR

Provider Business Mailing Address
First Line	:	5716 N JERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3616
Country	:	US
Telephone Number	:	773-914-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	5716 N JERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3616
Country	:	US
Telephone Number	:	773-914-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	11/11/2014

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