Healthcare Provider Details

I. General information

NPI: 1275369241
Provider Name (Legal Business Name): URIEL ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD
ARLINGTON HEIGHTS IL
60005-3929
US

IV. Provider business mailing address

415 W GOLF RD
ARLINGTON HEIGHTS IL
60005-3929
US

V. Phone/Fax

Practice location:
  • Phone: 847-258-5420
  • Fax:
Mailing address:
  • Phone: 847-258-5420
  • Fax: 847-258-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: