Healthcare Provider Details

I. General information

NPI: 1376671115
Provider Name (Legal Business Name): MRS. MARIA ISABEL REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 W 63RD ST
CHICAGO IL
60629-2753
US

IV. Provider business mailing address

2644 W CERMAK RD
CHICAGO IL
60608-3515
US

V. Phone/Fax

Practice location:
  • Phone: 773-805-8314
  • Fax: 773-523-2520
Mailing address:
  • Phone: 312-479-3258
  • Fax: 773-523-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056003500
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: