Andres S Ibanez, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.003404 Issued in IL

Practice address

6840 W Touhy Ave
Niles, IL 60714-4520

Phone

(773) 470-6464

NPI assigned

Jul 10, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1235570953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 KIRK ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023218",
            "telephone_number": "773-470-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6840 W TOUHY AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144520",
            "telephone_number": "773-470-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBANEZ",
        "first_name": "ANDRES",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.003404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Niles, IL
• Providers in Niles, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.