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DEEPIKA MEDAVARAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3400 W WASHINGTON ST, SPRINGFIELD, IL 62711-7917
(217) 787-9600
Mailing address
3621 BRANDONSHIRE DR, SPRINGFIELD, IL 62704-5554
(217) 793-3185

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001007
IL

Other

Enumeration date
08/12/2008
Last updated
08/12/2008
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