Individual
MARINE SUTRISNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
721 CROWN CT, SCHAUMBURG, IL 60193-3182
(312) 238-2460
Mailing address
721 CROWN CT, SCHAUMBURG, IL 60193-3182
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
056009695
IL
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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