Individual
NICOLE MARIE GRINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1525 E MAIN ST, STREATOR, IL 61364-3100
(815) 672-4516
Mailing address
1525 E MAIN ST, STREATOR, IL 61364-3100
(815) 672-4516
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001074
IL
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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