Active NPI
Antonio Mazza, OTD OTR/L
- Occupational Therapist
- Northbrook, IL
National Provider Identifier
1467104653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.013736
- Practice address
- 3000 Dundee Rd Ste 106
Northbrook, IL 60062-2424 - Phone
- (847) 480-7833
- NPI assigned
- Jan 19, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.013736 | IL | Primary |
Addresses
Primary practice location
3000 Dundee Rd Ste 106
Northbrook, IL 60062-2424
Mailing address
236 Washington Ave
Highwood, IL 60040-1107
Phone (847) 521-0181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.013736 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642550400000",
"number": "1467104653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "236 WASHINGTON AVE",
"city": "HIGHWOOD",
"state": "IL",
"postal_code": "600401107",
"telephone_number": "847-521-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 DUNDEE RD STE 106",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622424",
"telephone_number": "847-480-7833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZA",
"first_name": "ANTONIO",
"name_prefix": "Dr.",
"credential": "OTD OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-19",
"last_updated": "2022-01-19",
"certification_date": "2022-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.013736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.