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General NPI Number Information
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NPI Number | 1164003976
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Entity Type | Individual
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Provider Name | ALICIA LYNN SANDOVAL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE STE 700
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City | CHICAGO
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State | IL
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Zip | 60611-6662
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Country | US
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Telephone | 312-337-6960
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Fax | 312-337-3601
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Provider Business Mailing Address
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Address Line | 737 N MICHIGAN AVE STE 700
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City | CHICAGO
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State | IL
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Zip | 60611-6662
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Country | US
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Telephone | 312-337-6960
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Fax | 312-337-3601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.014089
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License Number State | IL
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