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General NPI Number Information
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NPI Number | 1710863147
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Entity Type | Individual
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Provider Name | RAY NIKKO GUCE MANALO
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 2773 SKOKIE VALLEY RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1042
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Country | US
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Telephone | 847-266-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 4851 N TRIPP AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2720
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Country | US
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Telephone | 773-822-3390
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.005400
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License Number State | IL
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