MEDICARE: MISS VERONICA ESPARZA 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	225X00000X	Occupational Therapist	056.010585	IL

General Provider Information

NPI Number	:	1902579493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VERONICA ESPARZA OTR/L

Provider Business Mailing Address
First Line	:	6211 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2530
Country	:	US
Telephone Number	:	773-827-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 W GEORGE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6624
Country	:	US
Telephone Number	:	312-650-5522
Fax Number	:

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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