MEDICARE: ANETA ESPINOSA OTR/L

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
1	224Z00000X	Occupational Therapy Assistant	057.003781	IL
2	225X00000X	Occupational Therapist	056.013967	IL

General Provider Information

NPI Number	:	1295128049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANETA ESPINOSA OTR/L

Provider Business Mailing Address
First Line	:	4346 N WOLCOTT AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1020
Country	:	US
Telephone Number	:	847-414-0459
Fax Number	:

Provider Business Practice Location Address
First Line	:	4346 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1020
Country	:	US
Telephone Number	:	847-414-0459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	11/25/2020

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