Provider Demographics
NPI:1194438705
Name:LEON, ROCIO ANGELICA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:ANGELICA
Last Name:LEON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 COLONY CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2957
Mailing Address - Country:US
Mailing Address - Phone:630-696-7684
Mailing Address - Fax:
Practice Address - Street 1:534 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2901
Practice Address - Country:US
Practice Address - Phone:630-300-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist