MEDICARE: CAROLINA E DIAZ OCCUPATIONAL THERAPY

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	057004744	IL

General Provider Information

NPI Number	:	1508704032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA E DIAZ OCCUPATIONAL THERAPY

Provider Business Mailing Address
First Line	:	5124 N OAK PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-3742
Country	:	US
Telephone Number	:	773-369-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5124 N OAK PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-3742
Country	:	US
Telephone Number	:	773-369-8305
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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