Healthcare Provider Details

I. General information

NPI: 1255945531
Provider Name (Legal Business Name): LAURA ELENA DUARTE PARRA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US

IV. Provider business mailing address

2518 1ST AVE
RIVER GROVE IL
60171-1743
US

V. Phone/Fax

Practice location:
  • Phone: 773-389-2202
  • Fax:
Mailing address:
  • Phone: 773-517-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-132959
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056015389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: