Provider Demographics
NPI:1215742762
Name:HOROWITZ, MAYA ELENA GUTIERREZ (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:ELENA GUTIERREZ
Last Name:HOROWITZ
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 1:2141 S TAN CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1998
Mailing Address - Country:US
Mailing Address - Phone:312-791-0418
Mailing Address - Fax:
Practice Address - Street 1:2141 S TAN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1998
Practice Address - Country:US
Practice Address - Phone:312-791-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005213224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant