Provider Demographics
NPI:1992308464
Name:VALLE CUADRA, MELISA (OTR/L)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:VALLE CUADRA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:30047 N WAUKEGAN RD
Mailing Address - Street 2:APT 112 (C/O ERIC SZCZEPINSKI)
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044
Mailing Address - Country:US
Mailing Address - Phone:330-956-0835
Mailing Address - Fax:
Practice Address - Street 1:1845 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3022
Practice Address - Country:US
Practice Address - Phone:847-386-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist