Provider Demographics
NPI:1366728669
Name:PINTO, PAOLA ANDREA (OTR)
Entity type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:ANDREA
Last Name:PINTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 LUKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7032
Mailing Address - Country:US
Mailing Address - Phone:786-443-1070
Mailing Address - Fax:
Practice Address - Street 1:509 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2422
Practice Address - Country:US
Practice Address - Phone:309-452-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13553225X00000X
IL056.012521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist