Provider Demographics
NPI:1215102223
Name:MONTALVO, RAQUEL DIANA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:DIANA
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 BEACON CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5937
Mailing Address - Country:US
Mailing Address - Phone:708-226-4883
Mailing Address - Fax:
Practice Address - Street 1:8916 BEACON CT
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60487-5937
Practice Address - Country:US
Practice Address - Phone:708-226-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist