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General NPI Number Information
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NPI Number | 1891418216
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Entity Type | Individual
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Provider Name | NICOLE CIBUZAR OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 2960 N LAKE SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60657-5600
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Country | US
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Telephone | 773-298-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 W NORWOOD ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60660-0214
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Country | US
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Telephone | 612-382-5593
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.014971
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License Number State | IL
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