Basic Information
| Provider Information | |||||||||
| NPI: | 1174198923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEGUZMAN | ||||||||
| FirstName: | MARIBEL | ||||||||
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| Credential: | OTD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 W 38TH ST APT 1 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606091840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174574771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 STEVENS ST | ||||||||
| Address2: | |||||||||
| City: | NOKOMIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620751442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175637725 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 20418-875 | WI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 056013683 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 056.013683 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.