Individual
LISA BETH WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6901 N GALENA RD, PEORIA, IL 61614-3193
(309) 692-4600
Mailing address
318 E CRAIG ST, PRINCEVILLE, IL 61559-9596
(309) 678-0363
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
057000996
IL
Other
Enumeration date
12/18/2021
Last updated
12/18/2021
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