Provider Demographics
NPI:1215154828
Name:MAXWELL-SOFIYEA, VALERIE (OT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MAXWELL-SOFIYEA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2819
Mailing Address - Country:US
Mailing Address - Phone:773-233-0756
Mailing Address - Fax:773-233-0756
Practice Address - Street 1:1666 W.103RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2819
Practice Address - Country:US
Practice Address - Phone:772-233-0756
Practice Address - Fax:773-233-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist