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NPI Code Detail

MEDICARE: EYAS LANDING, INC.

MEDICARE: EYAS LANDING, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2222Q00000XDevelopmental Therapist
32251P0200XPediatric Physical Therapist
4225XP0200XPediatric Occupational Therapist
5235Z00000XSpeech-Language Pathologist
6252Y00000XEarly Intervention Provider Agency056009137IL

General Provider Information

NPI Number : 1053621391
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYAS LANDING, INC.
Provider Business Mailing Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number : 312-253-1440
Provider Business Practice Location Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number : 312-253-1440
Authorized Official
Title or Position : OWNER
Name : DR. LAURA MRAZ
Credential : OTD
Telephone Number : 312-733-0883
Provider Enumeration Date : 10/20/2010
Last Update Date : 04/16/2025

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Directions to “EYAS LANDING, INC. ” Practice Location

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