Healthcare Provider Details

I. General information

NPI: 1871471805
Provider Name (Legal Business Name): MAIQUEL PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 REMINGTON BLVD STE 255
BOLINGBROOK IL
60440-4306
US

IV. Provider business mailing address

421 MORTON AVE
AURORA IL
60506-3704
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-5901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: