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NPI Code Detail

MEDICARE: MRS. GLORIA LEIVA OTR

MEDICARE: MRS. GLORIA LEIVA OTR
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
1225X00000XOccupational Therapist056.002800IL

General Provider Information

NPI Number : 1588267363
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLORIA LEIVA OTR
Provider Business Mailing Address
First Line : 4021 W BELMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-4771
Country : US
Telephone Number : 773-328-5544
Fax Number :
Provider Business Practice Location Address
First Line : 4021 W BELMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-4771
Country : US
Telephone Number : 773-328-5544
Fax Number : 773-328-5502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 11/16/2020

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Directions to “ MRS. GLORIA LEIVA OTR” Practice Location

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