Healthcare Provider Details

I. General information

NPI: 1265346514
Provider Name (Legal Business Name): VALERIA ZAMORES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4501 HILL RD
HIGHLAND IL
62249-3519
US

IV. Provider business mailing address

4501 HILL RD
HIGHLAND IL
62249-3519
US

V. Phone/Fax

Practice location:
  • Phone: 618-830-6562
  • Fax: 618-503-0263
Mailing address:
  • Phone: 618-830-6562
  • Fax: 618-503-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: