Provider Demographics
NPI:1043055353
Name:ESPARZA, KINBERLYN (DT)
Entity type:Individual
Prefix:
First Name:KINBERLYN
Middle Name:
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 W 96TH PL
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3012
Mailing Address - Country:US
Mailing Address - Phone:773-554-0805
Mailing Address - Fax:
Practice Address - Street 1:4825 W 96TH PL
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3012
Practice Address - Country:US
Practice Address - Phone:773-554-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist