Provider Demographics
NPI:1992351605
Name:MAZUREK, CLAIRE JEANETTE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:JEANETTE
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 N MELVINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3719
Mailing Address - Country:US
Mailing Address - Phone:773-814-5532
Mailing Address - Fax:
Practice Address - Street 1:8975 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5821
Practice Address - Country:US
Practice Address - Phone:847-296-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty