Healthcare Provider Details

I. General information

NPI: 1770825135
Provider Name (Legal Business Name): JOSEPH ALBERT MENDOZA MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST C100, M/C 889
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W TAYLOR ST C100, M/C 889
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-3700
  • Fax:
Mailing address:
  • Phone: 312-996-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number056.009192
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number056.009192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: