Provider Demographics
NPI:1508751678
Name:GARAZIN, ALEXANDRIA (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:GARAZIN
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 1:4020 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4416
Mailing Address - Country:US
Mailing Address - Phone:331-301-5590
Mailing Address - Fax:
Practice Address - Street 1:4020 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4416
Practice Address - Country:US
Practice Address - Phone:331-301-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005834224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant