Provider Demographics
NPI:1285173583
Name:CROSS, MARIA K (MOT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:K
Last Name:CROSS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3273
Mailing Address - Country:US
Mailing Address - Phone:224-623-3702
Mailing Address - Fax:
Practice Address - Street 1:530 N HOUGH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3087
Practice Address - Country:US
Practice Address - Phone:847-381-0090
Practice Address - Fax:847-381-0181
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011886225X00000X
IN31006344A225X00000X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist