Provider Demographics
NPI:1528103066
Name:BARBOSA, VANESSA MAZIERO (PHD, OTR L)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MAZIERO
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:PHD, OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 S PRAIRIE AVE UNIT 2007
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 S PRAIRIE AVE UNIT 2007
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3145
Practice Address - Country:US
Practice Address - Phone:312-945-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist