Individual
MRS. CRYSTAL MARY DIRKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
211 75TH ST, BURR RIDGE, IL 60527
(630) 230-1170
Mailing address
1S221 EUCLID AVE, VILLA PARK, IL 60181-3902
(630) 995-0408
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004588
IL
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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