Provider Demographics
NPI:1063300606
Name:ORTIZ, CARLA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 W WRIGHTWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0602
Mailing Address - Country:US
Mailing Address - Phone:630-788-2751
Mailing Address - Fax:
Practice Address - Street 1:3050 FINLEY RD STE 301
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1196
Practice Address - Country:US
Practice Address - Phone:331-775-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist