Provider Demographics
NPI:1063051878
Name:CASTILLO, ALEXIS JULIA (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JULIA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 193RD ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3731
Mailing Address - Country:US
Mailing Address - Phone:708-932-1639
Mailing Address - Fax:
Practice Address - Street 1:2919 193RD ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3731
Practice Address - Country:US
Practice Address - Phone:708-932-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005330224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant