Healthcare Provider Details

I. General information

NPI: 1154928141
Provider Name (Legal Business Name): RAYMUND ESPIRITU OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAY ESPIRITU OTR/L

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W MILLERS RD
DES PLAINES IL
60016-2674
US

IV. Provider business mailing address

559 W MILLERS RD
DES PLAINES IL
60016-2674
US

V. Phone/Fax

Practice location:
  • Phone: 224-619-2867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.013806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: