Individual
MR. KELLY ALAN WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
4334 WASHINGTON ST, DOWNERS GROVE, IL 60515-2837
(630) 971-0815
Mailing address
4334 WASHINGTON ST, DOWNERS GROVE, IL 60515-2837
(630) 971-0815
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.000794
IL
Other
Enumeration date
10/08/2009
Last updated
10/08/2009
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